What is the best inpatient diet for acute diverticulitis?

From the Guidelines

For acute diverticulitis requiring hospitalization, a clear liquid diet is initially recommended, progressing to a low-fiber diet as symptoms improve. This approach is based on the most recent and highest quality study, which advises a clear liquid diet during the acute phase of uncomplicated diverticulitis to improve patient comfort 1. The clear liquid diet includes water, broth, clear juices, gelatin, and tea or coffee without cream, allowing the bowel to rest while maintaining hydration.

As inflammation decreases and pain subsides, patients can transition to a low-fiber diet including white bread, refined cereals, eggs, lean meats, and well-cooked vegetables without skins or seeds. Key points to consider when advancing the diet include:

• Patient comfort and tolerance to the clear liquid diet
• Ability to maintain hydration and nutrition
• Gradual progression to a low-fiber diet to prevent irritation of the inflamed diverticula
• Eventual increase in fiber intake to 25-35 grams daily to help prevent recurrence, although the evidence for this is based on very low-quality evidence and should be considered in the context of patient preferences and potential side effects 1.

The initial bowel rest with clear liquids works because it reduces mechanical stimulation of the inflamed colon, while the gradual reintroduction of food minimizes the risk of exacerbating symptoms during the healing process. It is essential to note that the decision to advance the diet should be based on individual patient symptoms and response to treatment, with follow-up recommended if the patient is unable to advance their diet after 3-5 days 1.

From the Research

Inpatient Diet for Acute Diverticulitis

• The best inpatient diet for acute diverticulitis is a topic of ongoing research and debate 2.
• A systematic review of eight studies found "very low" quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms, and reoccurrence 2.
• The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis 2.
• A high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, is strongly recommended after the acute episode has resolved 2.

Dietary Recommendations

• There is limited evidence to support specific dietary recommendations for inpatient management of acute diverticulitis 2, 3, 4.
• However, a liberalised diet with a high fibre content may be beneficial in improving outcomes and reducing the risk of reoccurrence 2.
• More research is needed to determine the optimal dietary approach for inpatient management of acute diverticulitis 3, 4.

Antibiotic Treatment

• The use of antibiotics in acute uncomplicated diverticulitis is a topic of controversy, with some studies suggesting that they may not be necessary 3, 4.
• A systematic review of five studies found that the effect of antibiotics on complications, emergency surgery, recurrence, and long-term complications is uncertain 3.
• The quality of the evidence is low, and more trials are needed to determine the effectiveness of antibiotic treatment for acute uncomplicated diverticulitis 3, 4.