Materiały źródłowe

• #1 Prevention and Conservative Therapy of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4789966/

  Diverticular disease is a common problem. Prevention and treatment of complications depend on the stage of the disease. Lifestyle modifications are suitable preventive measures, aiming to reduce obesity and to balance the diet with a high amount of fiber and a low amount of meat. […] In stage 0 (asymptomatic diverticulosis), a high-fiber and vegetarian diet is recommended for the prevention of diverticulitis. Physical activity and normal body weight is regarded as beneficial. A fiber-rich diet also prevents cardiovascular disease, diabetes, and cancer and is therefore widely recommended. […] Numerous other studies, however, accounted for a significant effect of fibers to prevent diverticulosis. A study from Great Britain showed a reduced risk for vegetarians to be admitted to a hospital or to die related to diverticulitis. This epidemiological study included 47,033 men and women. 14,459 (33%) declared to be vegetarian. The risk for hospital admission due to diverticulosis was 4.4% for non-vegetarians compared with 3.0% for vegetarians. People with a fiber intake of 25.5 g/day had a 41% lower risk compared to people with a fiber intake of less than 14 g/day.

• #2 Preventing Recurrent Diverticulitis – Whole Health Library

  https://www.va.gov/WHOLEHEALTHLIBRARY/tools/preventing-recurrent-diverticulitis.asp

  Diverticulitis, which is inflammation of small pouches (diverticuli) that form in the colon, accounts for over 300,000 hospitalizations per year in the United States. […] Fortunately, there are some Whole Health approaches, particularly in terms of Food and Drink, that can help to reduce symptoms. […] Increased colonic pressure causes mucosal out-pouching. It may be helpful to reduce this elevated pressure through: Regular evacuation, Eating a plant-based diet, Stress reduction, Calcium channel blockers. This group of medications reduces smooth muscle contraction, lowering luminal pressure, and they have been associated with fewer recurrences. […] Of note, fiber has not been found to reduce the risk. However, it is perhaps best to have your patients try to meet daily nutritional recommendations for fiber, given it has benefits for so many other conditions. Furthermore, telling patients not to eat nuts and corn for fear of having those foods become entrapped in a tic is a myth, and does not hold true even after acute flares. As noted above, eating these foods is actually associated with reduced risk.

• #2 Preventing Recurrent Diverticulitis – Whole Health Library

  https://www.va.gov/WHOLEHEALTHLIBRARY/tools/preventing-recurrent-diverticulitis.asp

  Don’t give long-term antibiotics prophylactically for diverticulitis. They generally have not been found beneficial except in possibly relieving pain and bloating during exacerbations. […] Hold off on jumping right to surgery for diverticular disease. Many people will not have a recurrence. In one study of 3,165 patients hospitalized for diverticulitis, only 13.3% had a recurrence after 9 years. […] Consider mesalazine in those who have had a recurrence of diverticulitis. Reducing inflammation with this drug (but not NSAIDS, which can worsen risk) has been found beneficial when used cyclically for 10 days per month over 12 months. […] If a patient has diverticulitis and high blood pressure, consider a calcium channel blocker to reduce intraluminal pressure (and lower blood pressure as well). […] Although fiber has not been found to reduce the recurrence of diverticulitis, it does help reduce constipation, which can aggravate this condition. Encourage 7-9 servings of vegetables and fruit daily and, if this is not possible, consider supplementing with a soluble fiber such as psyllium, 1 tbsp in 12 oz of water twice daily.

• #3 Diverticular Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0800/diverticular-disease.html

  Diverticulitis prevention measures include consuming a vegetarian diet or high-quality diet (high in fruits, vegetables, whole grains, and legumes), limiting red meat and sweets, achieving or maintaining a body mass index of 18 to 25 kg per m2, being physically active, and avoiding tobacco and long-term nonsteroidal anti-inflammatory drugs. […] Measures for preventing recurrence of diverticulitis include consuming a vegetarian diet or high-quality diet (high in fruits, vegetables, whole grains, and legumes), limiting red meats and sweets, achieving or maintaining a body mass index of 18 to 25 kg per m2, being physically active, and avoiding tobacco and long-term nonsteroidal anti-inflammatory drugs. […] Prophylactic partial colectomy should be considered in patients who had an abscess requiring drainage. […] Surgical referral for partial colectomy after the third reoccurrence appears to be most cost-effective. […] Abscess formation requiring drainage increases the risk of recurrence, and prophylactic partial colectomy should be considered.

• #4 Diverticulitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

  To help prevent diverticulitis: […] Regular, vigorous exercise decreases the risk of diverticulitis. […] A high-fiber diet improves the movement of waste through the colon and decreases the risk of diverticulitis. Fiber-rich foods include fruits, vegetables, whole grains, seeds and beans. Cut back on red meats and sweets. […] Talk to your healthcare professional or a dietitian about goals for a healthy weight for you and strategies to reach your goals. […] Fiber works by absorbing water and increasing the soft, bulky waste in your colon. Drinking fluids improves the movement of waste and prevents constipation. […] Smoking and heavy alcohol use are associated with an increased risk of diverticulitis. […] In the past, healthcare professionals recommended that people with diverticulitis avoid nuts, seeds and popcorn. Studies have shown that these foods do not increase the risk of diverticulitis. Seeds and some nuts are good sources of fiber.

• #5 Prevention and Conservative Therapy of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4789966/

  A prospective study from Sweden showed that obesity is associated with a higher risk of complicated diverticular disease. […] In another Swedish study 36,592 women were included. A questionnaire evaluated BMI, physical activity, smoking, and other lifestyle-associated risk factors. During a follow-up of 12 years, 626 women underwent their first-time hospital admission for diverticulitis.

• #6 Evaluation, Management, and Prevention of Diverticular Disease – Practical Gastro

  https://practicalgastro.com/2022/05/17/evaluation-management-and-prevention-of-diverticular-disease/

  Diverticular disorders are frequently encountered in the primary care setting. […] To avoid these complications, patients should be encouraged to lead an active lifestyle, consume a healthy diet, and avoid tobacco, alcohol, and certain medications. […] There are numerous lifestyle interventions patients can follow to decrease risk of diverticulitis and other diverticular disorders. […] Rather, studies have associated diets that are low in fiber and high in red meat and refined sugars as leading to increased risk for the development of diverticular disease. […] Therefore, patients with diverticulosis should be encouraged to follow a high fiber diet which is low in red meat and refined sugars, and counseled to maintain an active lifestyle with the goal of achieving a normal body mass index.

• #6 Evaluation, Management, and Prevention of Diverticular Disease – Practical Gastro

  https://practicalgastro.com/2022/05/17/evaluation-management-and-prevention-of-diverticular-disease/

  Additionally, depending on each patients individual habits, they should be advised to quit smoking, and minimize use of opioids, alcohol, and NSAIDs whenever possible. […] While genetics are a significant factor in the development of diverticular disorders, patients should be counseled that lifestyle modifications including physical activity, healthy diet, and smoking cessation play important roles in decreasing risk for diverticular disease.

• #7 Diverticular Disease: A Crash Course for Clinicians

  https://www.gastroendonews.com/PRN/Article/02-23/Diverticular-Disease-A-Crash-Course-for-Clinicians/69341

  According to Dr. Stollman, the chief of the Division of Gastroenterology at Alta Bates Summit Medical Center, in Oakland, Calif., and an associate clinical professor of medicine at UCSF, maintenance of a low-risk lifestyle can effectively halve ones risk for developing diverticulitis. This includes limiting red meat to less than four servings a week, increasing fiber to more than 23 g daily, exercising vigorously for more than two hours per week, maintaining body mass index at 18.5-24.9 kg/m2 and not smoking. Each component lowers the risk significantly, and each should be recommended to patients. […] One important thing patients can do is increase their fiber intake. Dr. Stollman said an inverse relationship exists between fiber intake and clinically evident diverticular disease, as demonstrated in at least two large prospective cohort studies showing that the risk for symptomatic disease (i.e., diagnosis of diverticulitis or hospitalization) was reduced by approximately 40% in the highest versus the lowest quartiles of fiber intake.

• #7 Diverticular Disease: A Crash Course for Clinicians

  https://www.gastroendonews.com/PRN/Article/02-23/Diverticular-Disease-A-Crash-Course-for-Clinicians/69341

  Importantly, the study demonstrated that more recent dietary intake was a greater influence on risk than past intake, Dr. Stollman noted, dispelling the myth that changes in the diet wont affect existing diverticulosis. […] Another stubborn myth that persists is that nuts and seeds should be off-limits for patients with a history of acute diverticulitis. Theres literally no data in support of this, Dr. Stollman said. […] We rarely talk about physical activity and diverticular disease, but there are some data, again from the HPFS, suggesting that patients with a high level of activity have a 34% lower risk of acute diverticulitis, Dr. Stollman explained. […] Because of this evidence, Dr. Stollman suggested that elective use of NSAIDsnot including aspirin when it is indicatedbe avoided or minimized in all patients with a history of diverticulitis.

• #8 Diagnosis and Management of Acute Diverticulitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0501/p612.html

  Interventions to prevent recurrences of diverticulitis include increased intake of dietary fiber, exercise, and, in persons with a body mass index of 30 kg per m2 or higher, weight loss. […] Counseling for smoking cessation is recommended because smoking is associated with an increased incidence of complicated diverticulitis and less favorable outcomes (e.g., surgery at a younger age, higher risk of recurrence). […] Evidence from a prospective cohort study of 47,228 men in the United States found no evidence that avoiding nuts, corn, or popcorn decreases the risk of diverticulosis or diverticular complications, such as diverticulitis. […] A small prospective study found that mesalamine and Lactobacillus casei are effective in preventing recurrence. […] A meta-analysis of four randomized controlled trials with 1,660 patients who had experienced at least one episode of diverticulitis found that rifaximin (Xifaxan) plus fiber provided one year of complete symptom relief (number needed to treat = 3) and fewer complications (number needed to treat = 59) compared with fiber alone.

• #9 Diverticular disease and diverticulitis

  https://www.nhs.uk/conditions/diverticular-disease-and-diverticulitis/

  If you have diverticular disease or diverticulitis there are things you can do to reduce the risk of your symptoms getting worse in the future. […] eat a healthy, balanced diet including whole grains, fruits and vegetables there are no specific foods you need to avoid […] slowly increase how much fibre you eat if you do not eat much fibre and make sure to also drink plenty of water […] stop smoking if you smoke […] maintain a healthy weight […] do not take NSAIDs (such as ibuprofen) or opioid painkillers (such as codeine) they can cause stomach problems or constipation, and increase the risk of getting a hole (perforation) in your bowel.

• #10 New Guidelines Inform Diverticulitis Treatment | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2021/01/new-guidelines-inform-diverticulitis-treatment

  While a nutritious diet is a cornerstone of good health for everyone, patients with a history of diverticulitis should be especially mindful of their eating habits. […] When returning to solid foods, a vegetarian diet and a simple, high-fiber diet rich in fruits, vegetables, legumes and whole grains are associated with decreased diverticulitis risk. […] To further reduce risk, physicians should encourage patients to participate in vigorous exercise, stop smoking, maintain a healthy weight (obesity increases risk) and watch alcohol consumption. […] Currently there is no medication available to prevent recurrence of diverticulitis. Although multiple studies have examined rifaximin, probiotics, and 5-aminosalicylic acid (mesalamine) on diverticulitis recurrences, both AGA and ASCRS found insufficient evidence to support their use.

• #11 Diverticulitis diet: Foods to eat and avoid

  https://www.medicalnewstoday.com/articles/327259

  Certain foods can help during and after a diverticulitis flare-up. These include high fiber foods and probiotics. Foods to consider avoiding include red meat and high-FODMAP foods. […] The review concluded that there is not enough quality research to identify which diets are beneficial for an acute attack of diverticulitis. But they did suggest that following a high fiber diet after recovery from acute diverticulitis might reduce the risk of another episode. […] A 2017 study associated this type of diet with an increased risk of diverticulitis. […] One 2017 study found that if people stick to certain lifestyle recommendations, it might be possible to prevent 50% of diverticulitis cases. Recommendations from the study included consuming no more than 51 grams (g) of red meat a day, eating about 23 g of dietary fiber daily, doing at least 2 hours of vigorous exercise each week, maintaining a moderate weight, and never smoking.

• #12 Diverticular disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diverticular-disease-and-diverticulitis/

  Eating a high-fibre diet may help prevent diverticular disease, and should improve your symptoms. […] Your diet should be balanced and include at least 5 portions of fruit and vegetables a day, plus whole grains. Adults should aim to eat 18g (0.6oz) to 30g (1.05oz) of fibre a day, depending on their height and weight. […] Its recommended that you gradually increase your fibre intake over the course of a few weeks. This will help prevent side effects associated with a high-fibre diet, such as bloating and flatulence (wind). Drinking plenty of fluids will also help prevent side effects. […] If you have established diverticular disease, it may be suggested that you avoid eating nuts, corn and seeds due to the possibility that they could block the diverticular openings and cause diverticulitis. […] Probiotics have also been recommended, but evidence is lacking. Overall, there is a lack of good quality scientific evidence on how to prevent diverticular disease.

• #13 Diverticulitis Diet for Flare-Ups, Recovery, and Remission

  https://www.verywellhealth.com/what-to-eat-for-diverticulosis-1944730

  During remission and for prevention, the standard recommendation is to eat foods high in fiber with little or no red meat. […] Eating more fiber or taking fiber supplements can help prevent future attacks. […] Fiber softens stool and helps prevent constipation. Avoiding constipation aids in decreasing pressure in the colon, which may prevent future diverticulitis flare-ups. […] Add fiber-rich foods gradually with a goal of consuming 30-35 grams of fiber per day to help prevent diverticulitis flare-ups. […] A Mediterranean diet is high in fiber and low in processed foods and is associated with a reduced incidence of inflammation. […] The diverticulitis diet is often recommended because it reduces inflammation by eliminating or limiting certain inflammatory foods and promotes regular bowel movements, which may prevent diverticulitis in the future. […] Modifying your diet is an excellent first step to taking control of diverticulosis and diverticulitis. Dietary changes can help manage your symptoms and reduce diverticulitis flares.

• #14 Diverticular Disease and Diet | Patient Education | UCSF Health

  https://www.ucsfhealth.org/education/diverticular-disease-and-diet

  Diverticulosis is a condition in which small, bulging pouches (diverticuli) form inside the lower part of the intestine, usually in the colon. […] A diet rich in fiber can help keep stools soft and prevent inflammation. […] Dietary changes can help the colon heal. […] A high-fiber diet softens and gives bulk to the stool, allowing it to pass quickly and easily. […] Eat a high-fiber diet when you have diverticulosis. Fiber softens the stool and helps prevent constipation. It also can help decrease pressure in the colon and help prevent flare-ups of diverticulitis. […] The target is to eat 25 to 30 grams of fiber daily. Drink at least 8 cups of fluid daily. Fluid will help soften your stool. Exercise also promotes bowel movement and helps prevent constipation. […] After symptoms improve, usually within two to four days, you may add 5 to 15 grams of fiber a day back into your diet. Resume your high fiber diet when you no longer have symptoms.

• #15 Living with diverticulitis: Get the full scope of symptoms, treatment, and prevention | Digestive | UT Southwestern Medical Center

  https://utswmed.org/medblog/diverticulitis-symptoms-treatment/

  People with diverticulosis might not experience symptoms or complications that require treatment. […] Eating a high-fiber diet, rich in foods such as bran, whole-wheat pasta, apples, pears, raspberries, beans, sweet potatoes, avocados, and vegetables, can help prevent regular flare-ups. […] To help prevent recurring flare-ups, which happen in one-third of patients with uncomplicated diverticulitis, we recommend: A high-fiber diet rich in foods such as bran, whole-wheat pasta, apples, pears, raspberries, beans, sweet potatoes, avocados, and vegetables, Regular cardiovascular activity, Weight loss, if appropriate. […] Increase your fiber intake slowly to reduce gas and bloating and be sure to drink plenty of water at least 64 ounces a day. Fiber without 64 ounces of water per day will constipate you.

• #16 The dos and don’ts of managing diverticular disease – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/the-dos-and-donts-of-managing-diverticular-disease

  Don’t forget a healthy diet. Typical Western diets that are both low in fiber and high in saturated fats, including red meat, are associated with an increased risk for diverticulitis. […] „We still think a high-fiber diet is important because it’s good for heart health; reducing chronic inflammation; and making the bowels move regularly, which helps to maintain gut health and reduce pressure against diverticula,” Dr. Friedman says. […] Drink lots of water and aim for 25 to 30 grams of dietary fiber every day from beans, whole grains, vegetables, fruits, nuts, and seeds. […] „Yes, nuts and seeds foods once thought to trigger diverticulitis are actually full of fiber and are tied to many aspects of good health,” Dr. Friedman says. „You can eat a handful of nuts and seeds every day and your gut will thank you for it.”

• #16 The dos and don’ts of managing diverticular disease – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/the-dos-and-donts-of-managing-diverticular-disease

  Stay away from nuts and seeds, and don’t eat popcorn that’s what doctors said years ago if you had diverticulosis, a condition marked by tiny pouches (diverticula) that develop in the lining of the colon. […] „You don’t have to worry about eating nuts, seeds, or popcorn. The evidence does not show a higher risk of diverticulitis in people who eat a lot of those foods, compared with people who don’t,” says gastroenterologist Dr. Lawrence S. Friedman, a Harvard Medical School professor and the Anton R. Fried, M.D., Chair of the Department of Medicine at Newton-Wellesley Hospital. […] Living a healthy lifestyle is good for your gut. If you smoke, try to quit, and maintain a healthy weight. Smoking and obesity are associated with diverticular complications. […] Vigorous physical activity (like jogging, swimming laps, or playing tennis or basketball) is associated with a reduced risk of diverticulitis and diverticular bleeding.

• #17 Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33919755/

  Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. […] A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. […] Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.

• #18

  https://www.prevention.com/health/a20429066/17-techniques-to-treat-and-prevent-diverticulosis/

  Increase Your Fiber Intake Slowly […] Take 6 to 8 weeks to gradually increase your fiber intake to the recommended 30 to 35 grams each day, Klein suggests. You need time for your digestive system to adapt. You can expect bloating and gas in the first few weeks. But most people will get over this. […] Drink Lots Of Liquids […] Drink six to eight glasses of water a day, advises Klein, adding that the liquid is an important partner to fiber in combating constipation, which is associated with diverticulosis. Straining during a bowel movement tends to expand the diverticula through the walls of the colon, making the problematic pockets bigger. […] Go When You Have To Go […] If you dont yield to natures call, you defeat the purpose of adding more fiber to your diet and drinking more liquids. Dont suppress the need to move your bowel, Williamson advises.

• #18

  https://www.prevention.com/health/a20429066/17-techniques-to-treat-and-prevent-diverticulosis/

  Exercise […] It tones more than your legs and hips. Exercise also tones the muscles in your colon. It helps bowel movements; you dont have to strain as much, says Klein. […] Take It Easy With Ibuprofen And Acetaminophen […] Avoid high doses of ibuprofen, a common painkiller that is known as a nonsteroidal anti-inflammatory drug (NSAID). Regular and consistent use of acetaminophen is also associated with increased symptoms of diverticular disease. One study of more than 35,000 men found that those who took NSAIDs or acetaminophen at least two times a week were twice as likely to develop diverticular disease as men who didnt take the drugs regularly. NSAIDs inhibit prostaglandins, fatty acids that protect the cells in the intestinal tract. […] Best Fiber-Boosting Foods […] You know that getting enough fiber in your diet (30 to 35 grams daily) is the most important thing you can do to treat and prevent diverticulosis.

• #19 How To Prevent Diverticulitis & Flare Ups

  https://www.webmd.com/digestive-disorders/understanding-diverticulitis-prevention

  The best way to prevent diverticulitis is to modify your diet and lifestyle. […] Eat more fiber by adding whole-grain breads, oatmeal, bran cereals, fibrous fresh fruits, and vegetables to your diet. However, take care to add fiber gradually. A sudden switch to a high-fiber diet can cause bloating and gas. […] Drink plenty of fluids (at least eight 8-ounce glasses of water a day) if you increase your intake of fiber. […] Avoid refined foods, such as white flour, white rice, and other processed foods. […] Avoid red meat. There have been some studies that associate high red meat consumption with acute diverticulitis. […] Prevent constipation by trying over-the-counter stool softeners. However, don’t use suppositories or laxatives for constipation on a long-term basis without consulting your doctor. […] Exercise regularly. Exercise can help the muscles in your intestine retain their tone, which encourages regular bowel movements. If you have the urge to move your bowels, don’t delay or ignore it.

• #20

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abk6783

  You may be able to lower your chance of getting diverticulitis. You can do this by taking steps to prevent constipation. […] Eat fruits, vegetables, beans, and whole grains every day. These foods are high in fibre. […] Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink. […] Get at least 2 hours of moderate to vigorous exercise a week. Walking is a good choice. […] Take a fibre supplement (such as Benefibre or Metamucil) every day if needed. Read and follow all instructions on the label. […] Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.

• #21 Diverticulitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10352-diverticulitis

  Healthcare providers dont know enough about why diverticulitis happens or why it returns to know definitively how to prevent it. But they suspect that general bowel wellness can help. Eating more plants and fewer animal fats, drinking enough water and getting some regular exercise can help keep your bowel movements healthy. For some people, they might recommend fiber supplements or probiotics. […] In the past, people with diverticulosis were told to avoid seeds and nuts, in case one might get stuck in a diverticulum and cause diverticulitis. This risk is considered mostly a myth today. Seeds and nuts are great sources of fiber and plant-based protein, and they tend to appear in healthy meals. Its much better for your bowels to maintain a healthy diet overall than to worry about the rare chance of a seed going awry.

• #22 Diverticulosis & Diverticulitis | ACG

  https://gi.org/topics/diverticulosis-and-diverticulitis/

  Minimizing the use of non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin, may decrease the chances of developing diverticulitis. However, if you take aspirin for your heart or blood vessels, you should not stop aspirin without talking to your doctor. Opiate narcotics and corticosteroids also appear to predispose to diverticulitis. […] […] Several different medications have been studied in hopes of preventing recurrent diverticulitis in patients who have had one or more attacks. Unfortunately, the best studied drug, mesalamine, has not reduced the likelihood of recurrent diverticulitis. There are only a few small studies on the use of probiotics (healthy bacteria) or rifaximin (a kind of antibiotic), so it isn’t clear if these medications might help reduce recurrent diverticulitis.

• #23 Recommendations | Diverticular disease: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng147/chapter/recommendations

  Tell people about the benefits of exercise, and weight loss if they are overweight or obese, and stopping smoking, in reducing the risk of developing acute diverticulitis and symptomatic disease. […] Advise people to eat a healthy, balanced diet including whole grains, fruit and vegetables. […] Advise people to drink adequate fluid if they are increasing their fibre intake, especially if there is a risk of dehydration. […] Advise people to avoid non-steroidal anti-inflammatory drugs and opioid analgesia if possible, because they may increase the risk of diverticular perforation. […] Advise people that the benefits of increasing dietary fibre may take several weeks to achieve. […] If tolerated, a high-fibre diet should be maintained for life. […] Do not offer an aminosalicylate or antibiotics to prevent recurrent acute diverticulitis.

• #24 Diverticular disease and diverticulitis: causes, symptoms and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/diverticular-disease-and-diverticulitis-causes-symptoms-and-treatment

  Patients should be referred to a dietitian for advice on dietary modification of fibre intake. An increase in intake of soluble fibre can be advised, alongside laxatives. […] Adequate fluid intake (roughly 25–30mL/kg bodyweight) is recommended for everyone to reduce risk of constipation and is a major factor in the efficacy of laxatives, as well as to reduce the risk of associated intestinal obstruction. […] Paracetamol should be recommended to alleviate abdominal pain. NSAIDs and opioids should be avoided as they increase the risk of complications (e.g. perforation). […] In acute diverticulitis, antibiotics are recommended only if there is suspected infection, which include co-amoxiclav, ciprofloxacin, metronidazole and rifaximin, depending on local guidelines. […] The role of antibiotics in acute uncomplicated diverticulitis has been challenged.

• #25 Defend yourself from diverticulitis – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/defend-yourself-from-diverticulitis

  You can help prevent diverticulosis by drinking plenty of fluids and eating a high-fiber diet. Studies have suggested an association between low-fiber diets and diverticulosis, since the condition is less common in places like Asia and Africa, where people eat diets high in vegetable fiber compared with the typically low-fiber diets in America and Great Britain. […] Fiber helps to soften the stool so it can pass easily through the intestines. If the stool is too hard, constipation can occur. Straining to pass hard stool puts pressure on your colon, which may cause weak spots to bulge out. […] The Dietary Guidelines for Americans recommends at least 25-30 grams. The best sources of fiber include fresh fruits, vegetables, beans, nuts, corn, and foods containing wheat bran. […] If you have trouble getting enough fiber in your diet, a fiber supplement like Benefiber or Metamucil can help. „A tablespoon of any of these adds about 5 to 6 grams of fiber to your diet,” says Dr. Goldberg. Speak with your doctor before taking a fiber supplement, as adding too much to your diet at one time can cause gas and bloating.

• #26 Nutrition and healthy eating

  https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/diverticulitis-diet/art-20048499

  Over time, keep adding fiber to your diet by including high-fiber foods such as fruits, vegetables and whole grains. High-fiber foods may lower your chances of getting diverticulitis again. Drink lots of water to keep fiber moving through your digestive system. […] If you don’t get enough fiber from food, your healthcare professional may recommend a fiber supplement. […] Along with eating a balanced diet, aim to get regular physical activity. Moderate exercise such as water aerobics or brisk walking is linked with gut health. If you’re not active now, ask your healthcare professional to help you get started.

• #27 Diverticular Disease and Rifaximin: An Evidence-Based Review

  https://www.mdpi.com/2079-6382/12/3/443

  There have been considerable advances in the treatment of diverticular disease in recent years. […] Current evidence shows that cyclical rifaximin usage in conjunction with a high-fiber diet is safe and effective for treating symptomatic uncomplicated diverticular disease, while the cost-effectiveness of long-term treatment is unknown. […] The use of rifaximin to prevent recurrent diverticulitis is promising, but further studies are needed to confirm its therapeutic benefit. […] The importance of diet in the development of diverticulitis has been shown. Studies showed that consuming high-fiber foods, eating nuts (>2 times per week) and popcorn (<2 times per week), and a vegetarian diet reduced the risk of diverticulitis, whereas consumption of red meat increased the risk of diverticulitis.

• #27 Diverticular Disease and Rifaximin: An Evidence-Based Review

  https://www.mdpi.com/2079-6382/12/3/443

  In terms of primary prophylaxis of acute diverticulitis, the available studies on medical treatments are of low quality, and management is often based on experience rather than evidence. […] The use of medications, including rifaximin, for the primary prevention of diverticulitis in patients with diverticulosis is not supported by therapeutic reasoning and should be avoided. […] The use of rifaximin with fiber to prevent diverticulitis recurrence is encouraging, but the minimal therapeutic benefit needs a large and strong randomized controlled study for confirmation. […] Finally, there is no evidence that rifaximin is effective in the treatment of acute uncomplicated diverticulitis, thus it should not be used for this reason.

• #28 One-year cyclic therapy with rifaximin-α is effective …

  https://ppch.pl/seo/article/01.3001.0053.8079/en

  Cyclic therapy with rifaximin-α is effective in treating SUDD symptoms and in preventing the recurrence of symptoms, also in patients with a history of diverticulitis – regardless of how the diagnosis was made and disease complications. […] The management of SUDD as well as the premedication of the disease recurrence and exacerbation, were fairly well defined in previous studies. According to the guidelines, the treatment with rifaximin-α should consist of at least 12 cycles. […] Rifaximin-α can be effective in preventing recurring diverticulitis in patients with a history of at least one episode of diverticulitis, including complicated diverticulitis.

• #29

  https://journals.lww.com/ajg/fulltext/2015/10001/can_the_use_of_mesalamine_prevent_recurrent.1282.aspx

  To date, no therapy has been shown to prevent the recurrence of acute uncomplicated diverticulitis (AUD). […] Several early studies have suggested mesalamine may prevent recurrent AUD given its ability to reduce inflammation in colonic diverticular disease. However, in this meta-analysis, we have shown mesalamine does not appear to be superior to placebo in preventing an AUD or SUDD recurrence. Given a trend towards higher side effects rate in the mesalamine group, mesalamine should not be routinely recommended for the purpose of prevention of diverticulitis.

• #30 Colonic diverticular disease. Treatment and prevention | Gastroenterología y Hepatología

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-14-articulo-colonic-diverticular-disease-treatment-prevention-S021057051500103X

  The rationale for the use of antibiotics in symptomatic UDD is not clearly established. […] Rifaximin has been proposed. […] Rifaximin may decrease metabolic activity of bowel flora, increasing faecal mass, and may also eradicate bacterial overgrowth. […] Probiotics seem to be effective in preventing recurrence of ACD, but well designed studies are lacking. […] After one episode of ACD, about a third will have a second ACD, and after a second episode, a further third will have another attack. […] Once the acute episode has resolved, a high fibre diet is commonly recommended to reduce recurrences. […] Recent data show that natural history of ACD is much more benign than thought in the past. […] The American Society of Colon and Rectum Surgeons in their most recent guideline recommend that elective sigmoid resection after recovery from ACD should be made on a case-by-case basis.

• #31

  https://bpac.org.nz/2023/diverticulitis.aspx

  Few people with diverticulosis develop diverticulitis. […] Factors that increase the risk of developing diverticulitis include Western diets (often high in red meat and refined grains, and low in fibre), central obesity, smoking, some medicines, e.g. NSAIDs or opioids, and genetics. […] Advise patients who have recovered from acute diverticulitis to gradually introduce more dietary fibre to their diet and avoid NSAIDs to reduce the risk of future episodes. […] Lifestyle modifications to prevent the initial development of diverticulitis in patients with diverticulosis, e.g. reducing red meat intake and increasing dietary fibre, could potentially prevent the development of future episodes. […] Pharmacological prophylaxis is not recommended. […] Some patients may experience recurrent or chronic episodes of diverticulitis.

• #32 Understanding Diverticular Disease and Diverticulitis – Dr. Husain Gheewala – Colorectal Surgeon in Mumbai

  https://drhusaingheewala.com/understanding-diverticular-disease-and-diverticulitis/

  Preventing the progression from diverticular disease to diverticulitis involves early detection and prompt treatment. Here are some strategies to prevent both conditions: […] A balanced diet rich in fiber, regular exercise, and adequate hydration are key preventive measures. […] Regular consultations with a healthcare provider can help in early detection and management of diverticular disease. […] As doctors, it is essential to educate patients about the importance of a high-fiber diet and healthy lifestyle choices to prevent diverticular disease and its complications. […] Focuses on maintaining a high-fiber diet, staying hydrated, and regular exercise. […] Involves early detection and management of diverticular disease to prevent inflammation or infection.

• #33 Lifestyle Changes for Diverticular Disease | NYU Langone Health

  https://nyulangone.org/conditions/diverticular-disease/treatments/lifestyle-changes-for-diverticular-disease

  If you have symptoms of diverticulosis, such as abdominal pain, bloating, and constipation, your NYU Langone gastroenterologist may suggest making lifestyle changes to help you feel better and prevent complications, such as infection and bleeding. […] A diet high in fiber helps to keep stool soft, easing its passage through the colon. It can also reduce inflammation in the colon. Foods that are high in fiber include grains, fruits, vegetables, and beans. […] If you are diagnosed with diverticulitis, in which an infection occurs, your doctor may temporarily recommend other dietary approaches while you heal. […] Physical activity helps keep your bowels moving. […] Studies have found that smoking increases the risk of complications of diverticular disease, such as bleeding or diverticulitis. […] Water, clear fluids, and vegetable juice can help keep stool soft. If you’re taking fiber supplements, it’s important to drink plenty of water to prevent constipation.

• #33 Lifestyle Changes for Diverticular Disease | NYU Langone Health

  https://nyulangone.org/conditions/diverticular-disease/treatments/lifestyle-changes-for-diverticular-disease

• #34 Advances in Diverticulitis Treatment and Prevention – Mass General Advances in Motion

  https://advances.massgeneral.org/digestive-health/video.aspx?id=1186

  Diverticulitis is one of the most common gastrointestinal conditions that patients present with to primary care clinics and to gastroenterologists. Unfortunately, there has not been much progress made in how we can prevent diverticulitis. […] Our hope is that these research findings can be translated into effective clinical interventions by having doctors actually being able to recommend a patient-specific lifestyle intervention that could reduce the risk of having a flare. So this could include, for example, helping patients understand what foods might be better to eat and what foods might be better to avoid, and also encouraging patients to observe healthy lifestyle habits, like staying more active and trying to keep their body weight low. […] This, I think, potentially could have a huge impact in terms of preventing patients from developing diverticulitis and ultimately requiring surgery; as such, I think this represents from a population scale, a very real intervention that could have significant public health benefits.

• #34 Advances in Diverticulitis Treatment and Prevention – Mass General Advances in Motion

  https://advances.massgeneral.org/digestive-health/video.aspx?id=1186

  We know preventing disease can lower costs for the health care system and can also affect more individuals and have an impact that stretches beyond effective treatment. […] Unfortunately, there is not a lot of research being done on disease prevention. There are also very few resources being focused on disease prevention. So research at Mass General and research in my group will hopefully be examples of how disease prevention research can be important and can have an important impact.

• #35 Diverticular Disease | Division of Gastroenterology

  https://gastro.uw.edu/research/Diverticular

  Research in diverticular disease by our faculty has led to a better understanding of the natural history of diverticular disease and the phenotyping of patients who have diverticular disease. Studies are aimed at helping prevent recurrent episodes of diverticulitis, the most severe outcome of diverticulosis. […] If successful, this study will provide the groundwork for a large-scale intervention for the prevention of recurrent diverticulitis. […] However, these modifiable risk factors have not been evaluated for secondary prevention. […] The Mediterranean diet pattern is comparable to diets associated with the primary prevention of diverticulitis, is more strongly associated with reduced inflammation, and is familiar to providers and many patients. […] Her work has informed guidelines, changed dietary recommendations, and formed the basis of current medical measures for prevention of diverticulitis.

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