What is the treatment for mild diverticulosis?

Treatment for Mild Diverticulosis

For mild diverticulosis, the primary treatment is a high-quality, fiber-rich diet (25-40g/day) from fruits, vegetables, whole grains, and legumes, along with maintaining regular physical activity and achieving a normal body mass index. 1, 2

Dietary Management

• A high-quality diet rich in fiber from fruits, vegetables, whole grains, and legumes, while low in red meat and sweets, is the cornerstone of diverticulosis management 1
• Fiber intake should be gradually increased to 20-30 grams daily to reduce intraluminal pressure and prevent progression to diverticulitis 3
• Contrary to outdated beliefs, there is no need to restrict nuts, corn, popcorn, or small-seeded fruits, as these are not associated with increased risk of diverticulitis 1
• Adequate hydration is important to complement the high-fiber diet 2

Preventive Measures

• Regular physical activity, particularly vigorous exercise, helps decrease the risk of diverticulitis 1
• Maintaining or achieving a normal body mass index is recommended to reduce risk 1
• Smoking cessation is advised as smoking increases diverticulitis risk 1
• Avoiding regular use of NSAIDs and opiates when possible, as these medications are associated with increased risk of diverticulitis 4

When Symptoms Develop

• For symptomatic diverticulosis without inflammation, fiber supplementation (such as psyllium) may provide symptom relief 5
• Some evidence suggests that combination therapy with soluble fiber (like glucomannan) and poorly absorbed antibiotics (like rifaximin) given 7-10 days monthly may help manage symptoms 5
• If chronic symptoms persist, evaluation with both imaging and lower endoscopy is recommended to exclude ongoing inflammation 4
• For chronic abdominal pain after diverticulitis with no evidence of inflammation, low to modest doses of tricyclic antidepressants may be considered 4

Monitoring and Follow-up

• Patients should understand that approximately 50% of diverticulitis risk is attributable to genetic factors 1
• Only 1-4% of patients with diverticulosis will develop acute diverticulitis in their lifetime 6
• Regular monitoring is not required for asymptomatic diverticulosis 7

Acute Diverticulitis Management

• If diverticulosis progresses to uncomplicated diverticulitis, a clear liquid diet is advised during the acute phase, advancing as symptoms improve 4
• For mild uncomplicated diverticulitis in immunocompetent patients, antibiotics can be used selectively rather than routinely 4, 8
• Antibiotics are indicated for patients with risk factors including: immunocompromised status, comorbidities, frailty, refractory symptoms, vomiting, CRP >140 mg/L, WBC >15 × 10^9/L, or fluid collection/longer segment of inflammation on CT 4, 8
• When antibiotics are necessary, oral options include amoxicillin-clavulanate or ciprofloxacin plus metronidazole for 4-7 days 4, 6

Special Considerations

• Immunocompromised patients require a lower threshold for CT imaging, antibiotic treatment, and surgical consultation 4
• Elderly patients with uncomplicated diverticulitis may benefit from antibiotic therapy even with mild disease 8
• Patients with persistent symptoms despite appropriate management should undergo further diagnostic evaluation 9