From the Guidelines
Treatment for diverticulosis primarily involves dietary modifications and lifestyle changes, with a high-fiber diet being the cornerstone of management, aiming for 25-35 grams of fiber daily. This approach is supported by the American Gastroenterological Association (AGA) suggestions, which include advising patients with a history of acute diverticulitis to follow a fiber-rich diet or fiber supplementation 1. The AGA also suggests advising patients with diverticular disease to consider vigorous physical activity, which promotes normal bowel function 1.
Key Components of Treatment
- A high-fiber diet introduced gradually to avoid bloating and gas
- Fiber supplements like psyllium (Metamucil) or methylcellulose (Citrucel) if dietary fiber is insufficient
- Adequate hydration with at least 8 glasses of water daily
- Regular physical activity
- Avoidance of medications that may increase the risk of complications, such as non-steroidal anti-inflammatory drugs (NSAIDs)
Rationale
The rationale behind these measures is to soften stool and reduce pressure within the colon, which prevents the formation of new diverticula and reduces the risk of existing ones becoming inflamed. The AGA suggests against routinely advising patients with a history of diverticulitis to avoid consumption of seeds, nuts, and popcorn, or the use of aspirin 1, indicating that these factors may not significantly impact the management of diverticulosis.
Outcome
By following these dietary and lifestyle modifications, most people with diverticulosis can remain asymptomatic, and the risk of complications such as diverticulitis can be minimized. Regular follow-up with a healthcare provider is recommended to monitor the condition and adjust the treatment plan as necessary. The AGA recommendations emphasize a personalized approach, considering patient-specific factors such as access to medical care, immunosuppression, operative comorbidities, and patient preference in decisions regarding management 1.
From the Research
Treatment Options for Diverticulosis
- The treatment of diverticulosis is generally based on a high-fibre diet and antibiotics, respectively 2.
- Rifaximin and mesalazine have been found to be effective in treating symptomatic uncomplicated diverticular disease 2, 3.
- A high-fibre diet appears to decrease the likelihood of symptomatic diverticulitis, and the role of diet in preventing diverticular disease has long been debated 4.
- The use of probiotics in diverticular disease and in preventing acute diverticulitis occurrence/recurrence appears promising but inconclusive 2.
- Available evidence suggests that antibiotics have a role only in the treatment of complicated diverticulitis 2.
Medical Management
- Cyclic antibiotic therapy, such as rifaximin, may be used for symptom treatment and prevention of diverticulitis onset in uncomplicated diverticular disease 5.
- However, the cost-efficacy of this treatment is still uncertain, and a high-fibre diet may be a more cost-effective option 5.
- Mesalazine has been found to be effective in preventing acute diverticulitis in patients with symptomatic uncomplicated diverticular disease 2.
Dietary Considerations
- A high-fibre diet does not protect against asymptomatic diverticulosis, and may even be associated with a greater prevalence of diverticulosis 6.
- The role of fibre in treating diverticulosis remains unclear, and further research is needed to determine the optimal dietary approach 2, 6.
- A diet high in whole grains, fruits, and vegetables is recommended for overall health, but its specific effect on diverticulosis is still uncertain 4.