From the Guidelines

Probiotics are not recommended for diverticulitis.

The American Gastroenterological Association (AGA) suggests against the use of probiotics after acute uncomplicated diverticulitis due to the very low quality of evidence and current uncertainties of the role of the microbiome in diverticulitis 1.
A meta-analysis of seven randomized controlled trials found no benefit in comparing 5-aminosalicylic acid to control for prevention of recurrent diverticulitis, and there is insufficient evidence to support the use of any probiotic or cyclic rifaximin to prevent diverticulitis 1.
Key points to consider include:
- The AGA recommends against the use of mesalamine after acute uncomplicated diverticulitis 1.
- A fiber-rich diet or fiber supplementation is suggested in patients with a history of acute diverticulitis 1.
- Patients with a history of diverticulitis should not be treated with 5-aminosalicylic acid, probiotics, or rifaximin to prevent recurrent diverticulitis 1.

The decision to perform elective prophylactic colonic resection in patients with an initial episode of acute uncomplicated diverticulitis should be individualized, taking into account patient-specific factors such as access to medical care for recurrent diverticulitis, immunosuppression, operative comorbidities, and patient preference 1.

From the Research

The use of probiotics in the treatment of diverticulitis has been studied, with some evidence suggesting their potential benefits 2, 3, 4, 5, 6.
A systematic review of 11 studies on diverticular disease patients treated with probiotics found that the available data do not permit conclusions on the efficacy of probiotics due to the poor quality of the retrieved studies 2.
However, another study found that probiotics can modify the gut microbiota and attenuate experimentally induced acute diverticulitis by restoring the colonic antioxidant status, ameliorating inflammation, and decreasing apoptosis 3.
The role of specific probiotic strains, such as Limosilactobacillus reuteri, has also been investigated, with evidence suggesting their anti-inflammatory and immunomodulating effects may be beneficial in treating diverticulitis 4.
Despite the potential benefits, current guidelines state that there is insufficient evidence to recommend probiotics for symptom relief in patients with diverticular disease due to the heterogeneity and poor quality of the available studies 5, 6.

Probiotics may lead to symptoms improvement by modifying the gut microbiota and are promising treatments for diverticular disease 2, 6.
The effectiveness of probiotics in treating diverticulitis may depend on the specific strain used, with Lactobacilli and Bifidobacterium lactis showing potential benefits 3, 4.
Further investigation is required to understand how probiotics can be employed in the treatment of diverticulitis and to provide evidence-based recommendations 2, 5.