From the Guidelines
Diverticulosis treatment should primarily focus on dietary modifications and lifestyle changes, with a high-fiber diet being the cornerstone of management, as recommended by the American Gastroenterological Association 1.
Key Recommendations
- A high-fiber diet aiming for 25-35 grams of fiber daily through fruits, vegetables, whole grains, and legumes is essential for managing diverticulosis, as it helps reduce pressure in the colon and prevent stool from becoming trapped in the diverticula 1.
- Patients should increase fiber intake gradually to avoid bloating and gas, and adequate hydration with at least 8 glasses of water daily helps prevent constipation and supports bowel function.
- Regular physical activity promotes healthy bowel movements, and patients with diverticular disease should consider vigorous physical activity 1.
- For mild symptoms, over-the-counter fiber supplements like psyllium (Metamucil) at 1 teaspoon 1-3 times daily mixed with water can be helpful.
- Avoiding seeds, nuts, and popcorn is no longer universally recommended as evidence doesn't support that these foods trigger symptoms 1.
- During flare-ups, patients may temporarily switch to a low-fiber diet until symptoms improve.
- If diverticulosis progresses to diverticulitis (inflammation of the diverticula), medical treatment with antibiotics like ciprofloxacin 500mg twice daily plus metronidazole 500mg three times daily for 7-10 days may be necessary, but the use of antibiotics should be selective rather than routine 1.
- Patients with a history of diverticulitis should not be treated with 5-aminosalicylic acid, probiotics, or rifaximin to prevent recurrent diverticulitis 1.
Additional Considerations
- Elective colonic resection is not recommended for patients with an initial episode of acute uncomplicated diverticulitis, and the decision to perform elective prophylactic colonic resection should be individualized 1.
- Patients with diverticulitis should be advised to avoid the use of nonaspirin NSAIDs if possible, and to consider the potential risks and benefits of elective surgery, including the risk of short-term and long-term complications 1.
From the Research
Diverticulosis Treatment Options
- High-fibre diet: Studies have shown that a high-fibre diet can improve symptoms and prevent complications of diverticular disease 2, 3.
- Rifaximin: A non-absorbable antibiotic that has been shown to be effective in treating symptomatic uncomplicated diverticular disease, especially when used in conjunction with a high-fibre diet 4, 5.
- Dietary fibre modification: Liberalised diets, as opposed to dietary restrictions, are conditionally recommended for adults with acute, uncomplicated diverticulitis, and a high dietary fibre diet is strongly recommended after the acute episode has resolved 3.
Mechanism of Action
- High-fibre diet: The exact mechanism is not well established, but it is thought to prevent symptoms or complications of diverticular disease by increasing the bulk of stool and promoting regular bowel movements 2.
- Rifaximin: Its low systemic absorption and high concentration in stools make it an excellent medicine for targeting the gastrointestinal tract, where it has a beneficial effect in addition to its antibacterial properties 4.
- Interaction between rifaximin and dietary fibre: Rifaximin has been shown to improve the benefits of dietary fibre in uncomplicated diverticular disease by preventing its bacterial degradation 5.
Evidence Quality
- The quality of evidence for a high-fibre diet in the treatment of diverticular disease is mostly level 2 and level 3, with high-quality evidence lacking 2.
- The quality of evidence for dietary fibre modification in the recovery and prevention of reoccurrence of acute, uncomplicated diverticulitis is "very low" 3.
- The evidence for the use of rifaximin in treating symptomatic uncomplicated diverticular disease is promising, but further studies are needed to confirm its therapeutic benefit 4.