Acute diverticulitis: no evidence for low-fiber diet or bowel rest

  • Dahl C & al.
  • Nutrients

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Current evidence does not support restricted diet or bowel rest for patients with acute, uncomplicated diverticulitis.
  • Authors conditionally recommend solid food for inpatients and strongly recommend a high-fiber diet after resolution, absent contraindications.

Why this matters

  • Though “bowel rest” via food or fiber restriction is often recommended during acute diverticulitis, evidence suggests inefficacy and/or harm.
  • Low-fiber diets and probiotics are often recommended upon symptom resolution, but recent reviews have not addressed this.

Key results

  • Most studies had unclear or high bias risk in multiple domains.
  • Liberalized vs low-fiber diets for acute episodes (5 studies):
    • Length of stay (LOS): most found shorter LOS with liberalized diet;
    • Recurrence (2 studies): no significant difference between groups;
    • Treatment failure (3 studies): no significant difference between groups;
    • For all above outcomes, results could not be pooled, evidence quality was very low.
  • Modified diets after symptom resolution (3 studies): no conclusions; very low-quality evidence.

Study design

  • Systematic review through March 2017.
  • All participants were adults with acute, uncomplicated diverticulitis who undertook dietary interventions during or immediately after the episode.
  • Primary outcome: hospital LOS.
  • Funding: None.

Limitations

  • Few randomized controlled trials.
  • Studies were heterogeneous, low quality.
  • Recommendations do not come from a “robust multidisciplinary guideline panel.”