Treating chronic diverticular disease

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If diverticula (pouches in the intestine) constantly cause symptoms, it is referred to as chronic diverticular disease. This condition rarely leads to serious complications. A change in diet and certain medications can sometimes relieve the symptoms. If that’s not effective enough, bowel surgery is an option.

There are two main forms of chronic diverticular disease:

  • Symptomatic uncomplicated diverticular disease (SUDD): This form is characterized by constant (chronic) or recurrent symptoms such as pain, bloating and irregular bowel movements. There are often no signs of .
  • Recurrent diverticulitis: In this form, the diverticula keep becoming inflamed or infected. Although this doesn’t always lead to complications, abscesses may develop.

It’s not always possible to clearly differentiate between the two forms. Some people have both chronic symptoms and recurrent inflammations. But the treatment options are different.

How is symptomatic uncomplicated diverticular disease treated?

The treatment options for this condition include a change in diet, medication and surgery.

Diet

There is some initial to suggest that a high-fiber diet can reduce digestive problems caused by diverticular disease. This kind of diet mainly consists of a lot of fruit, grains, vegetables and legumes (e.g. beans and peas). It makes the stool (“poop”) softer, increases the volume of stool and stimulates digestion. This helps the stool move through the intestine faster and reduces the pressure on the wall of the intestine. Some people who have bowel problems add linseed and psyllium husk to their diet. These contain soluble fiber that binds to water in the intestine. Because of this, people who eat a lot of fiber are also advised to make sure they drink enough fluids.

The intestine contains different types of and other microorganisms (gut flora) that play an important role in how well it works and how healthy it is. These include lactic acid and bifidobacteria. Some people with diverticula have abnormal gut flora. For this reason, it is thought that probiotics containing these bacteria might be able to help. Studies do in fact suggest that probiotics can sometimes reduce digestive problems, as they sometimes do in (IBS). But it’s not yet clear which products may help in different situations.

Medications

The prescription-only medication mesalamine, also known as mesalazine, has been approved for use in the treatment of the chronic inflammatory bowel diseases known as and . If it is used in the treatment of diverticular disease, it has to be used “off-label.” Mesalamine is usually taken every day for several months. Studies have suggested that it can relieve the symptoms in some people. Due to a lack of studies, though, it isn’t yet possible to know for sure how effective mesalamine really is.

Surgery

Bowel surgery can sometimes relieve the symptoms. But it is associated with certain risks and there is no guarantee that it will make the symptoms go away.

How is recurrent diverticulitis treated?

Each new episode of diverticulitis is treated like a first acute episode. Antibiotics are important in complicated diverticulitis, but they aren’t always needed in uncomplicated diverticulitis. Complicated diverticulitis – where pus-filled abscesses have formed – has to be treated in a hospital. Surgery is needed if there is an increased risk of serious complications such as peritonitis (inflamed inner lining of the tummy) or blood poisoning (septicemia).

There are various treatments for the prevention of recurrent diverticulitis. These include antibiotics, mesalamine and a high-fiber diet. When tested in studies, though, they weren’t found to effectively prevent inflammations.

People who have diverticulitis shouldn’t take painkillers like ibuprofen or diclofenac (non-steroidal , or NSAIDs) because these medications can increase the risk of complications such as intestinal perforation.

It’s important to carefully consider the pros and cons of surgery for recurrent diverticulitis before making a decision. Surgery is quite unlikely to prevent complications of diverticulitis. And operations are always associated with risks. If someone also has chronic symptoms in between acute episodes, surgery might provide relief.

Andeweg CS, Berg R, Staal JB, ten Broek RP, van Goor H. Patient-reported Outcomes After Conservative or Surgical Management of Recurrent and Chronic Complaints of Diverticulitis: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14(2): 183-190.

Carabotti M, Annibale B, Severi C, Lahner E. Role of Fiber in Symptomatic Uncomplicated Diverticular Disease: A Systematic Review. Nutrients 2017; 9(2): pii: E161.

Carter F, Alsayb M, Marshall JK, Yuan Y. Mesalamine (5-ASA) for the prevention of recurrent diverticulitis. Cochrane Database Syst Rev 2017; (10): CD009839.

Lahner E, Bellisario C, Hassan C, Zullo A, Esposito G, Annibale B. Probiotics in the Treatment of Diverticular Disease. A Systematic Review. J Gastrointestin Liver Dis 2016; 25(1): 79-86.

Leifeld L, Germer CT, Böhm S, Dumoulin FL, Häuser W, Kreis M et al. S2k-Leitlinie Divertikelkrankheit/Divertikulitis. Z Gastroenterol 2014; 52(7): 663-710.

Morris AM, Regenbogen SE, Hardiman KM, Hendren S. Sigmoid diverticulitis: a systematic review. JAMA 2014; 311(3): 287-297.

Picchio M, Elisei W, Brandimarte G, Di Mario F, Malfertheiner P, Scarpignato C et al. Mesalazine for the Treatment of Symptomatic Uncomplicated Diverticular Disease of the Colon and for Primary Prevention of Diverticulitis: A Systematic Review of Randomized Clinical Trials. J Clin Gastroenterol 2016; 50 (Suppl 1): S64-69.

Van de Wall BJ, Stam MA, Draaisma WA, Stellato R, Bemelman WA, Boermeester MA et al. Surgery versus conservative management for recurrent and ongoing left-sided diverticulitis (DIRECT trial): an open-label, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol 2017; 2(1): 13-22.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on May 17, 2018
Next planned update: 2021

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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