From the Guidelines
A clear liquid diet is advised during the acute phase of uncomplicated diverticulitis, with the goal of advancing the diet as symptoms improve. This approach is supported by the American Gastroenterological Association's clinical practice update on medical management of colonic diverticulitis, which suggests that a clear liquid diet can provide greater comfort to patients during the acute phase 1. The rationale behind this recommendation is that diverticulitis can cause mechanical obstruction and/or systemic inflammation, and a clear liquid diet may help alleviate these symptoms.
Key components of the diet include:
- Clear liquids such as water, broth, and clear juices without pulp
- Gelatin and tea may also be tolerated
- Avoiding high-fiber foods and irritants such as seeds, nuts, and popcorn during the acute phase
As symptoms improve, the diet can be advanced to a low-fiber diet, and eventually to a high-fiber diet to prevent future flares 1. It is essential to stay well-hydrated throughout the process to prevent constipation. If a patient is unable to advance their diet after 3-5 days, they should follow up immediately for further evaluation and guidance.
From the Research
Diet for Acute Diverticulitis
- The management of acute diverticulitis typically involves a clear liquid diet, as stated in the study published in Critical care nursing clinics of North America 2.
- A clear liquid diet is often recommended as part of the medical management of acute diverticulitis, in addition to antibiotics 2.
- However, there is limited information available on the specific dietary recommendations for acute diverticulitis, and more research is needed to determine the most effective dietary approach.
- The use of antibiotics in uncomplicated acute diverticulitis is still a topic of debate, with some studies suggesting that they may not be necessary 3, 4.
- In terms of dietary management, the focus is often on bowel rest and hydration, with a gradual introduction of solid foods as symptoms improve 2, 4.
Treatment Approaches
- The treatment of acute diverticulitis depends on the severity of the disease, with uncomplicated cases often managed outpatient with bowel rest and antibiotics, while complicated cases may require hospitalization and surgical intervention 5, 4.
- The classification of diverticulitis as complicated or uncomplicated is based on CT scan, severity of symptoms, and patient history, and is used to direct management 4.
- Non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses, while larger abscesses may require percutaneous drainage 4.
- Surgical intervention is indicated for peritonitis or in failure of non-operative management 4.
Evidence-Based Treatment Strategies
- Evidence-based treatment strategies for acute diverticulitis have evolved over time, with a focus on risk-adapted treatment approaches and operative decision-making based on patient and disease factors 5.
- Clinical trials have demonstrated the effectiveness of laparoscopic lavage for select patients with Hinchey III disease, and primary resection with anastomosis and defunctioning stoma may be considered in some cases of Hinchey IV disease 5.
- The use of antibiotics in uncomplicated acute diverticulitis is still a topic of debate, with some studies suggesting that they may not be necessary 3, 4.