From the Guidelines
To prevent diverticulitis in the future, patients should consume a high-quality diet, achieve or maintain a normal body mass index, routinely be physically active, and not smoke, as recommended by the American Gastroenterological Association 1. The key to preventing diverticulitis recurrence is to adopt a healthy lifestyle, which includes:
- Eating a high-fiber diet with 25-30 grams of fiber daily through fruits, vegetables, whole grains, and legumes, as a prudent dietary pattern is associated with decreased risk of incident diverticulitis 1
- Gradually increasing fiber intake to avoid gas and bloating, and drinking plenty of water to help fiber work effectively
- Engaging in regular physical activity for 30 minutes most days to maintain bowel regularity and reduce constipation risk, as physical activity decreases the risk of diverticulitis 1
- Avoiding or limiting foods that may trigger symptoms, such as red meat, processed foods, and spicy items
- Maintaining a healthy weight, as obesity increases diverticulitis risk 1
- Avoiding non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen when possible, as they may increase diverticulitis risk 1 Additionally, patients with a history of diverticulitis should understand that approximately 50% of the risk for diverticulitis is attributable to genetic factors 1. It is also important to note that the American College of Physicians recommends against using mesalamine to prevent recurrent diverticulitis, as high-certainty evidence shows that it results in no difference in risk for recurrent diverticulitis compared with placebo 1. Elective surgery may be considered to prevent recurrent diverticulitis after initial treatment in patients who have either uncomplicated diverticulitis that is persistent or recurs frequently or complicated diverticulitis, as it is likely cost-effective in patients with acute uncomplicated diverticulitis that persists or recurs frequently or with acute complicated left-sided colonic diverticulitis 1.
From the Research
Prevention of Diverticulitis
To prevent diverticulitis, several measures can be taken:
- Increase dietary fiber intake to 25-40 g/day, which plays a crucial role in prevention and nonpharmacological treatment of uncomplicated diverticular disease 2
- Eat a well-balanced diet rich in vegetables, fruit, whole grain products, seeds, and nuts 2, 3
- Drink an appropriate amount of water and exclude products that decrease colonic transit time from the diet 2
- Maintain a healthy weight, as obesity is a risk factor for diverticular disease 2, 4
- Engage in regular physical activity, as low physical activity is a risk factor for diverticular disease 2
- Avoid smoking, as it is a risk factor for diverticular disease 2
Dietary Recommendations
Dietary recommendations for preventing diverticulitis include:
- A high-fiber diet, which may help prevent recurrent diverticulitis, although direct evidence is limited 3, 5
- Eating nuts, corn, and popcorn, which may have a protective effect and do not increase the risk of diverticulitis 3
- Avoiding a low-fiber diet, which is a risk factor for diverticular disease 2, 5
Pharmacological Treatment
Pharmacological treatment for diverticular disease is limited, and evidence is scarce:
- Rifaximin plus fiber supplementation may be effective in obtaining symptom relief and preventing complications in symptomatic uncomplicated diverticular disease 6
- Mesalazine may have an effect on pain relief in diverticular disease, but its effect on diverticulitis is limited 4
- Antibiotics are not proven to be effective in patients with uncomplicated diverticulitis and without further risk factors 4