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Background As a specific scale to evaluate the severity of hemorrhoids, Giordano severity of hemorrhoidal symptom questionnaire (GSQ) has been used to evaluate hemorrhoids in clinical practice many times in recent years. However, the effectiveness of GSQ score has not been verified yet, so it is necessary to carry out research to evaluate its clinical value. Objective The purpose of this study is to verify the validity of GSQ in evaluating the severity of hemorrhoids, and explore its ability to distinguish between surgical patients and non-surgical patients, and evaluate its value in guiding clinical treatment of hemorrhoids. Methods From November 2021 to November 2022, patients who were diagnosed with hemorrhoid in anorectal departments of six hospitals, including Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing Anorectal Hospital, the First Affiliated Hospital of China University of Science and Technology, Taiyuan Hospital of Traditional Chinese Medicine, Dongguan First Affiliated Hospital of Guangdong Medical University and the Third Affiliated Hospital of Yunnan University of Chinese Medicine, were investigated by questionnaire. The demographic data, GSQ score, Goligher grade, Visual analogue scale (VAS) score of hemorrhoid severity, Chinese version of HF-QoL (HF-QoL-C), Hemorrhoidal disease symptom score (HDSS) and other information were collected through standardized questionnaires. Then compared the GSQ scores of patients with different Goligher grades and different treatment schemes (drug treatment or surgical treatment), and explored the correlation between GSQ score and VAS score of hemorrhoid severity and HDSS score. The receiver's operating characteristic (ROC) curve was drawn to analyze the effectiveness of GSQ score in predicting the surgical treatment demand, and determine the best cutoff value. According to the cut-off value, patients were divided into low group and high group, and the differences of quality of life scores between the two groups were compared. Results A total of 707 questionnaires were distributed and 671 valid questionnaires were recovered (the effective recovery rate was 94.9%). The GSQ scores of patients with different Goligher grades were significantly different (P<0.001). The GSQ score of patients receiving surgery was higher than that of patients receiving medication (P<0.001). GSQ score was positively correlated with VAS score of hemorrhoid severity and HDSS score (rs=0.599, 0.801, P<0.001). ROC curve showed that the area under the curve predicted by GSQ score was 0.760 (95%CI=0.722-0.799), the best cutoff value was 12.5 points, the sensitivity was 62.3%, and the specificity was 79.5%. According to GSQ score, patients were divided into low group (GSQ score≤12, n=366) and high group (GSQ score ≥13, n=306). The total score of HF-QoL-C in high group was higher than that in low group (P<0.05). Conclusion GSQ can effectively reflect the severity of hemorrhoid disease and provide reference for the formulation of clinical treatment plan. When GSQ score is≥13 points, surgical treatment can be given priority.