From the Guidelines
The recommended management for diverticulosis primarily focuses on dietary modifications and lifestyle changes, with a high-fiber diet as the cornerstone of management, as suggested by the most recent guidelines 1. The management of diverticulosis aims to prevent constipation and reduce intraluminal pressure in the colon, which helps minimize the risk of developing diverticulitis.
- A high-fiber diet is recommended, with patients advised to consume 25-35 grams of fiber daily through fruits, vegetables, whole grains, and legumes.
- Fiber supplements like psyllium (Metamucil) or methylcellulose (Citrucel) at doses of 3-6 grams daily can be added if dietary intake is insufficient, as suggested by the American Gastroenterological Association 1.
- Adequate hydration with 8-10 glasses of water daily is essential to prevent constipation.
- Regular physical activity helps maintain bowel regularity.
- Patients should avoid medications that increase the risk of complications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), as recommended by the World Journal of Emergency Surgery 1.
- There is no need for routine antibiotics or surgical intervention for uncomplicated diverticulosis.
- Additionally, patients with a history of diverticulitis should avoid smoking, achieve or maintain a normal body mass index, and routinely be physically active, as recommended by the AGA clinical practice update 1. It's essential to note that diverticulosis itself is often asymptomatic and discovered incidentally; these management strategies are primarily preventive measures against progression to symptomatic disease. The decision to perform an elective resection after one or more episodes of acute diverticulitis should be undertaken on a case-by-case basis, taking into account risk factors, complications, age, and severity of episodes, as well as the patient’s personal circumstances and comorbidities, as suggested by the World Journal of Emergency Surgery 1.
From the Research
Management of Diverticulosis
The recommended management for diverticulosis includes:
- A high-fibre diet, which is widely accepted as a potential preventative measure for diverticulosis and its complications, although high-quality evidence is lacking 2
- Fibre supplementation, which may be beneficial in preventing recurrent diverticulitis, as shown in a proof-of-concept study where patients receiving fibre supplementation with intermittent rifaximin had a lower incidence of recurrences 3
- Avoiding low-residue diets, as there is no evidence to support their use in diverticular disease, and instead focusing on increasing fibre intake 4
Prevention of Recurrent Diverticulitis
To prevent recurrent diverticulitis:
- A high-fibre diet may be beneficial, although direct evidence is limited 5
- Intermittent rifaximin plus fibre supplementation may be effective in reducing the risk of recurrences, as shown in a proof-of-concept study 3
- There is no evidence to support avoiding nuts and seeds, and in fact, they may have a protective effect 5
Dietary Recommendations
Dietary recommendations for diverticulosis include: