From the Guidelines
Diverticulosis treatment should primarily focus on dietary modifications and lifestyle changes, with a high-fiber diet being the cornerstone of management, aiming for 25-35 grams of fiber daily, as there is no evidence to support the use of 5-aminosalicylic acid, probiotics, or rifaximin to prevent recurrent diverticulitis 1.
Key Components of Treatment
- A high-fiber diet should be introduced gradually to avoid gas and bloating, with patients drinking plenty of water (at least 8 glasses daily) to help fiber work effectively.
- Regular exercise, such as walking 30 minutes daily, helps maintain bowel regularity.
- Fiber supplements like psyllium (Metamucil), methylcellulose (Citrucel), or calcium polycarbophil (FiberCon) can be taken daily if dietary fiber is insufficient.
- Avoiding seeds and nuts is no longer considered necessary as research hasn't shown they increase complications.
- For occasional constipation, stool softeners like docusate sodium (100-300 mg daily) may help.
Additional Considerations
- Patients should be educated on the importance of a healthy lifestyle, including maintaining a normal body mass index, being physically active, not smoking, and avoiding nonsteroidal anti-inflammatory drug use except aspirin prescribed for secondary prevention of cardiovascular disease 1.
- Genetic factors also contribute to diverticulitis risk, and patients should understand that the risk of complicated diverticulitis is highest with the first presentation.
- Elective segmental resection should be personalized to consider severity of disease, patient preferences and values, as well as risks and benefits, rather than being advised based on the number of episodes 1.
From the Research
Treatment Options for Diverticulosis
- High-fibre diet: Studies have shown that a high-fibre diet can improve symptoms and prevent complications of diverticular disease 2. However, high-quality evidence for a high-fibre diet in the treatment of diverticular disease is lacking.
- Antibiotics: Antibiotics, such as rifaximin, have been shown to be effective in obtaining symptom relief and preventing complications in patients with uncomplicated diverticular disease 3, 4, 5.
- Rifaximin: Rifaximin has been demonstrated to be effective in obtaining symptoms relief at 1 year in patients with uncomplicated diverticular disease and to improve symptoms and maintain periods of remission following acute colonic diverticulitis (AD) 3, 4, 5.
- Probiotics: The use of probiotics in treating diverticulitis and diverticular disease has not yet been clearly demonstrated, but theoretical framework and preliminary studies suggest a potential beneficial effect 6.
Management of Diverticular Disease
- Uncomplicated diverticular disease: Antibiotics, such as rifaximin, are recommended in selected patients, and outpatient management is considered the best strategy in the majority of uncomplicated patients 3.
- Complicated diverticular disease: Inpatient management and intravenous antibiotics are necessary, while surgery is considered the standard therapy in patients where percutaneous drainage fails or peritonitis develops 3.