Abstract
Diverticular disease is among the most clinically and economically significant gastroenterological conditions in people > 65 years of age. Most people > 65 years of age will develop colonic diverticulae (herniate pouches) potentially caused by high colon intraluminal pressure. While 80% of the population with colonic diverticula remain asymptomatic, approximately 20% may develop abdominal symptoms (symptomatic uncomplicated diverticular disease), and in some individuals there may be eventual complications such as severe bouts of diverticulitis or bleeding that may lead to sepsis and death.
In aging populations, the widespread intake of low fiber Western diets; increased intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) naturally from whole foods or added to processed foods; and weight gain leading to obesity are several factors that may increase the risk of diverticular disease, bouts of symptoms, or its complications.
Five prospective studies suggest that fiber-rich healthy diets and low red or processed meat consumption significantly decrease the risk of diverticular disease.
Although a number of intervention trials suggest that fiber-rich diets and foods or supplements containing wheat bran, psyllium, or methylcellulose may help to alleviate diverticular disease symptoms and/or improve bowel function, there are presently a limited number of high-quality trials.
Fiber-related mechanisms associated with potentially reduced diverticular disease risk or alleviation of symptoms are related to improved colonic health including improved laxation and stool bulk and a healthier microbiota ecosystem with higher fecal concentration of probiotic bacteria and butyrate, lower inflammation, and improved body weight and visceral fat regulation.
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Tursi A. Diverticulosis today: unfashionable and still under-researched. Ther Adv Gastroenterol. 2016;9(2):213–28.
Templeton AW, Strate LL. Updates in diverticular disease. Curr Gastroenterol Rep. 2013;15(8):339–46.
Jacobs DO. Diverticulitis. N Engl J Med. 2007;357:2057–66.
Tursi A, Papagrigoriadis S. Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther. 2009;30:532–46.
Tursi A. Diverticular disease: a therapeutic overview. World J Gastrointest Pharmacol Ther. 2010;1(1):27–35.
Tursi A, Papa A, Danese S. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Aliment Pharmacol Ther. 2015;42:664–84.
Muhammad A, Lamendola O, Daas A, et al. Association between colonic diverticulosis and prevalence of colorectal polyps. Int J Color Dis. 2014;29(8):947–51.
Cuomo R, Barbara G, Andreozzi P, et al. Symptom patterns can distinguish diverticular disease from irritable bowel syndrome. Eur J Clin Investig. 2013;43(11):1147–55.
Jaruvongvanich V, Sanguankeo A, Wijarnpreecha K, Upala S. Risk of colorectal adenomas, advanced adenomas and cancer in patients with colonic diverticular disease: systematic review and meta-analysis. Dig Endosc. 2017;29:71–82. doi:10.1111/den12701.
Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of western civilization. BMJ. 1971;2:450–4.
Reinhard T. Diverticular disease—a reexamination of the fiber hypothesis. Today’s Dietitian. 2014;16(3):46.
Uno Y, Velkinburgh JC. Logical hypothesis: low FODMAP diet to prevent diverticulitis. World J Gastrointest Pharmacol Ther. 2016;7(4):503–12.
Strate LL, Keeley BR, Cao Y, et al. Western dietary pattern increases and prudent dietary pattern decreases, risk of incident diverticulitis in a prospective cohort study. Gastroenterology. 2017;152:1023–30.e2. doi:10.1053/jgastro.2016.12.038.
Commane DM, Arasaradnam RP, Mills S, et al. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J Gastroenterol. 2009;15(20):2479–88.
Wilkins T, Embey K, George R. Diagnosis and management of acute diverticulitis. Am Fam Physician. 2013;87(9):612–20.
Wick JY. Diverticular disease: eat your fiber? Consult Pharm. 2012;27(9):613–8.
Aldoori W, Ryan-Harshman M. Preventing diverticular disease. Review of recent evidence on high-fibre diets. Can Fam Physician. 2002;48:1632–7.
Sheth AA, Longo W, Floch MH. Diverticular disease and diverticulitis. Am J Gastroenterol. 2008;103:1550–6.
Tursi A, Elisei W, Picchio M, et al. Moderate to severe and prolonged left lower-abdominal pain is the best symptom characterizing symptomatic uncomplicated diverticular disease of the colon a comparison with fecal calprotectin in clinical setting. J Clin Gastroenterol. 2015;49(3):218–21.
Jeyarajah S, Akbar N, Moorhead J, et al. A clinicopathological study of serotonin of the sigmoid colon mucosa in association with chronic symptoms in uncomplicated diverticulosis. Int J Color Dis. 2012;27(12):1597–605.
Krokowicz L, Stojcev Z, Kaczmarek FB, et al. Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis-a prospective randomized study. Int J Color Dis. 2014;29:387–93.
Daniels L, Budding AE, deKorte K, et al. Fecal microbiome analysis as a diagnostic test for diverticulitis. Eur J Clin Microbiol Infect. 2014;33(11):1927–36.
Jung H-K, Choung RS, Locke GR, et al. Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: a population-based study. Am J Gastroenterol. 2010;105(3):652–61.
Böhm SK. Risk factors for diverticulosis, diverticulitis, diverticular perforation, and bleeding: a plea for more subtle history taking. Viszeralmedizin. 2015;31:84–94.
Aldoori WH, Giovannucci EL, Rimm EB, et al. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol. 1995;5:221–8.
Sharara AI, El-Halabi MM, Mansour NM, et al. Alcohol consumption is a risk factor for colonic diverticulosis. J Clin Gastroenterol. 2013;47(5):420–5.
Hjern F, Wolk A, Hakansson N. Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: a prospective cohort study. Am J Gastroenterol. 2012;107:296–302.
Usai P, Ibba I, Lai M, et al. Cigarette smoking and appendectomy: effect on clinical course of diverticulosis. Dig Liver Dis. 2011;43(2):98–101.
Kvasnovsky CL, Papagrioriadis S, Bjarnason I. Increased diverticular complications with NSAIDs and other medications: a systematic review and meta-analysis. Color Dis. 2014;16:189–96.
Strate LL. Lifestyle factors and the course of diverticular disease. Dig Dis. 2012;30:35–45.
Horner JL. Natural history of diverticulosis of the colon. Am J Dig Dis. 1958;3(5):343–50.
Strate LL, Liu YL, Syngal S, et al. Nut, corn and popcorn consumption and the incidence of diverticular disease. JAMA. 2008;300(8):907–14.
Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ. 2011;343 doi:10.1136/bmj.d4131.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diverticular disease. 2013; NIH Publication No. 13–1163.
Tarleton S, DiBaise JK. Low-residue diet in diverticular disease: putting an end to a myth. Nutr Clin Pract. 2011;26:137–42.
Gear JS, Ware A, Fursdon P, et al. Symptomless diverticular disease and intake of dietary fibre. Lancet. 1979;1(8115):511–4.
Peery AF, Sandler RS, Ahnen DJ, et al. Constipation and a low-fiber diet are not associated with diverticulosis. Clin Gastroenterol Hepatol. 2013;11(12):1622–7.
Peery AF, Barrett PR, Park D, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142(2):266–72.
Crowe FL, Balkwill A, Cairns BJ, et al. Source of dietary fibre and diverticular disease incidence: a prospective study of UK women. Gut. 2014;63:1450–6.
Aldoori WH, Giovannucci EL, Rockett HRH, et al. Prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr. 1998;128:714–9.
Aldoori WH, Giovannucci EL, Rimm EB, et al. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr. 1994;60:757–64.
Lahner E, Esposito G, Zullo A, et al. High fibre diet and Lactobacillus paracasei B21060 in symptomatic uncomplicated diverticular disease. World J Gastroenterol. 2012;18(41):5918–24.
Smits BJ, Whitehead AM, Prescott P. Lactulose in the treatment of symptomatic diverticular disease: a comparative study with high-fibre diet. Br J Clin Pract. 1990;44:314–8.
Ornstein MH, Littlewood ER, Baird IM, et al. Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial. BMJ. 1981;282:1353–6.
Brodribb AJ. Treatment of symptomatic diverticular disease with a high fibre diet. Lancet. 1977;1:664–6.
Hodgson WJ. The placebo effect is important in diverticular disease? Am J Gastroenterol. 1977;67:157–62.
Taylor I, Duthie HL. Bran tablets and diverticular disease. Br Med J. 1976;1(6016):988–90.
Leahy AL, Ellis RM, Quill DS, Peel ALG. High fibre diet in symptomatic diverticular disease of the colon. Ann R Coll Surg Eng. 1985;67(3):173–4.
Hyland JM, Taylor I. Does a high fibre diet prevent the complications of diverticular disease? Br J Surg. 1980;67:77–9.
Eastwood MA, Smith AN, Brydon WG, et al. Comparison of bran, ispaghula, and lactulose on colon function in diverticular disease. Gut. 1978;19:1144–7.
Brodribb AJ, Humphreys DM. Diverticular disease: three studies. III. Metabolic effect of bran in patients, with diverticular disease. Br Med J. 1976;1(6007):428–30.
Painter NS, Almeida AZ, Colebourne KW. Unprocessed bran in treatment of diverticular disease of the colon. Br Med J. 1972;2(5806):137–40.
Carabotti M, Annibale B, Severi C, Lahner E. Role of fiber in symptomatic uncomplicated diverticular disease: a systematic review. Forum Nutr. 2017;9:161. doi:10.3390/nu9020161.
Unlu C, Daniles L, Vrouenraets BC, et al. A systematic review of high-fibre dietary therapy in diverticular disease. Int J Colorectal. 2012;27:419–27.
Maconi G, Barbara G, Bosetti C, et al. Treatment of diverticular disease of the colon and prevention of acute diverticulitis: a systematic review. Dis Colon Rectum. 2011;54(10):1326–38.
Dahl WJ, Stewart ML. Position of the Academy of Nutrition and Dietetics: health implications of dietary fiber. J Acad Nutr Diet. 2015;115:1861–70.
European Food Safety Authority (EFSA). Scientific opinion on dietary reference values for carbohydrates and dietary fibre. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA), Parma, Italy. EFSA J. 2010;8(3):1462.
Slavin JL. Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc. 2008;108:1716–31.
Slavin J. Fiber and prebiotics: mechanisms and health benefits. Forum Nutr. 2013;5:1417–35.
Eswaran S, Muir J, Chey WD. Fiber and functional gastrointestinal disorders. Am J Gastroenterol. 2013;108(5):718–27.
Cummings JH. The effect of dietary fiber on fecal weight and composition. In: Spiller GA, editor. CRC handbook of dietary fiber in human nutrition. 3rd ed. Boca Raton, FL: CRC; 2001. p. 183–241.
Stevens J, VanSoest PJ, Robertson JB, Levitsky DA. Comparisons of the effects of psyllium and wheat bran on gastrointestinal transit time and stool characteristics. J Am Diet Assoc. 1988;88(3):323–6.
de Vries J, Miller PE, Verbeke K. Effects of cereal fiber on bowel function: a systematic review of intervention trials. World J Gastroenterol. 2015;21(29):8952–63.
Koh A, De Vadder F, Kovatcheva-Datchary P, Backhed F. From dietary fiber to host physiology: short-chain fatty acids as key bacterial metabolites. Cell. 2016;165:1332–45.
Pituch-Zdanowska A, Banaszkiewicz A, Albrecht P. The role of dietary fibre in inflammatory bowel disease. Prz Gastroenterol. 2015;10(3):135–41.
Conlon MA, Bird AR. The impact of diet and lifestyle on gut microbiota and human health. Forum Nutr. 2015;7:17–44.
Lynch DB, Jeffery IB, Cusack S, et al. Diet microbiota health interactions in older subjects: implications for healthy aging. Interdiscip Top Gerontol. 2015;40:141–54.
Claesson MJ, Jeffery IB, Conde S. Gut microbiota composition correlates with diet and health in the elderly. Nature. 2012;488:178–85.
Hamer HM, Jonkers D, Venema K, et al. Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther. 2008;27:104–19.
Kopylov U, Ben-Horin S, Lahat A, et al. Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion. 2012;86:201–5.
Nagata N, Sakamoto K, Arai T, et al. Visceral fat accumulation affects risk of colonic diverticular hemorrhage. Int J Color Dis. 2015;30(10):1399–406.
Strate LL, Liu YL, Aldoori WH, et al. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009;136:115–22.
Slavin JL. Dietary fiber and body weight. Nutrition. 2005;21:411–8.
Davis JN, Hodges VA, Gillham B. Normal-weight adults consume more fiber and fruit than their age- and height-matched overweight/obese counterparts. J Am Diet Assoc. 2006;106:833–40.
Liu S, Willett WC, Manson JE, et al. Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women. Am J Clin Nutr. 2003;78:920–7.
Fogelholm M, Anderssen S, Gunnarsdottir I, Lahti-Koski M. Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review. Food Nutr Res. 2012;56 doi:10.3402/fnr.v56i0.19103.
Lindstrom J, Peltonen M, Eriksson JG, et al. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study. Diabetologia. 2006;49:912–20.
Ma Y, Olendzki BC, Wang J, et al. Single-component versus multi-component dietary goals for the metabolic syndrome: a randomized trial. Ann Intern Med. 2015;162:248–57.
Dietary Guidelines Advisory Committee (DGAC). Scientific Report. Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. Part D. Chapter 2: dietary patterns, foods and nutrients and health outcomes; 2015. p. 1–35.
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Dreher, M.L. (2018). Fiber and Diverticular Disease. In: Dietary Fiber in Health and Disease. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-50557-2_8
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DOI: https://doi.org/10.1007/978-3-319-50557-2_8
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