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Diverticulosis and Diverticular Disease

Diverticula are small pouches or pockets in the wall of the digestive system, most often the large intestine. When these pouches become inflamed, this characterizes diverticular disease. Diverticula are quite common in older individuals, and often do not cause symptoms.

Targeted natural interventions including probiotics, butyrate, and fiber may help decrease symptoms and improve diverticular disease.

Figure 1: The Spectrum of Conditions Associated with Diverticula

 

Signs and Symptoms

  • Acute diverticulitis causes pain in the lower left abdomen that tends to worsen with movement.

Causes and Risk Factors

  • Factors currently known to increase risk of diverticulosis include advancing age, obesity, and smoking.
  • Factors known to increase risk of diverticulitis include low-fiber diet, sedentary lifestyle, obesity, smoking, alcohol consumption, and use of NSAIDs and pain relievers.

Diagnosis

  • Since it is asymptomatic in most people, diverticulosis is usually found incidentally during an unrelated diagnostic or screening procedure.
  • Computed tomography (CT) scan or abdominal ultrasound are the preferred diagnostic imaging modalities to establish a diagnosis of diverticular disease.
  • Mild cases of uncomplicated diverticular disease may be confused with irritable bowel syndrome.

Conventional Treatment

  • Asymptomatic diverticulosis does not require treatment.
  • Conservative treatment for uncomplicated diverticulitis includes a liquid or low-residue diet and oral antibiotics.
  • In complicated diverticulitis, hospitalization with intravenous fluids, antibiotics, or surgery may be required.

Novel and Emerging Strategies

  • Fecal calprotectin, a non-invasive stool test, is under investigation as a biomarker that may help identify diverticular disease.
  • An analysis of four randomized controlled trials found rifaximin (Xifaxan), an antibiotic with a favorable safety profile, plus fiber supplementation was associated with better symptom relief, fewer complications, and a better chance of being symptom-free after one year compared with fiber supplementation alone.
  • A randomized controlled trial using mesalamine (Asacol) in patients with acute diverticulitis found the rate of complete response was significantly higher in patients receiving mesalamine versus placebo.

Dietary and Lifestyle Considerations

  • Plant-based diets that are high in fiber may protect against diverticular disease.
  • Contrary to popular belief, nut and popcorn consumption may reduce the risk of diverticulitis rather than increase it.
  • Physical activity and maintaining a healthy weight may reduce the incidence of diverticular disease.

Note: A low-fiber diet is often recommended during the initial healing phase after an episode of acute diverticulitis. People recovering from an episode should ask their healthcare provider about consuming fiber.

Integrative Interventions

  • Probiotics: By helping restore the balance of intestinal flora and reduce inflammation in the intestine, probiotic supplementation may be of benefit in both acute and chronic diverticular problems.
  • Butyrate: In a randomized clinical trial of sodium butyrate in 52 people with diverticular disease, less than 7% of those in the butyrate group experienced diverticulitis symptoms compared with slightly more than 31% in the placebo group.
  • Fiber: Gradually increasing fiber until consumption reaches 20–30 g of fiber daily has been recommended by some diverticular disease researchers. Supplemental fiber in a form like psyllium seed husk can help increase total daily fiber intake.
  • Fish oil: Several university-associated medical centers recommend supplementing omega-3 fatty acids, including from fish oil, in diverticular disease, as these have anti-inflammatory activity.
  • Curcumin: Studies in animal models have shown curcumin can inhibit tumor necrosis factor-alpha, one of the inflammatory chemical messengers associated with diverticular disease and acute diverticulitis.