A systematic review of high-fibre dietary therapy in diverticular disease.

PURPOSE: The exact pathogenesis of diverticular disease of the sigmoid colon is not well established. However, the hypothesis that a low-fibre diet may result in diverticulosis and a high-fibre diet will prevent symptoms or complications of diverticular disease is widely accepted. The aim of this review is to assess whether a high-fibre diet can improve symptoms and/or prevent complications of diverticular disease of the sigmoid colon and/or prevent recurrent diverticulitis after a primary episode. METHODS: Clinical studies were eligible for inclusion if they assessed the treatment of diverticular disease or the prevention of recurrent diverticulitis with a high-fibre diet. The following exclusion criteria were used for study selection: studies without comparison of the patient group with a control group. RESULTS: No studies concerning prevention of recurrent diverticulitis with a high-fibre diet met our inclusion criteria. Three randomised controlled trials (RCT) and one case-control study were included in this systematic review. One RCT of moderate quality showed no difference in the primary endpoints. A second RCT of moderate quality and the case-control study found a significant difference in favour of a high-fibre diet in the treatment of symptomatic diverticular disease. The third RCT of moderate quality found a significant difference in favour of methylcellulose (fibre supplement). This study also showed a placebo effect. CONCLUSION: High-quality evidence for a high-fibre diet in the treatment of diverticular disease is lacking, and most recommendations are based on inconsistent level 2 and mostly level 3 evidence. Nevertheless, high-fibre diet is still recommended in several guidelines.

Low-residue diet in diverticular disease: putting an end to a myth.

Residue refers to any indigestible food substance that remains in the intestinal tract and contributes to stool bulk. Historically, low-residue diets have been recommended for diverticulosis because of a concern that indigestible nuts, seeds, corn, and popcorn could enter, block, or irritate a diverticulum and result in diverticulitis and possibly increase the risk of perforation. To date, there is no evidence supporting such a practice. In contrast, dietary fiber supplementation has been advocated to prevent diverticula formation and recurrence of symptomatic diverticulosis, although this is based mostly on low-quality observational studies. This report focuses on the evidence that fiber intake may be beneficial in the prevention and recurrence of symptomatic and complicated diverticular disease and provides recommendations regarding fiber supplementation in individuals with diverticulosis.

[Diverticular disease of the colon in peritoneal dialysis]. / La malattia diverticolare del colon nella dialisi peritoneale.

Colon diverticular disease is a very common pathology in western countries and represents a risk factor for septic-type complications, especially in peritoneal dialysis patients. We examined both diagnostic procedure and therapeutics options, either pharmacological or surgical. Ultrasonography, which is useful for the diagnosis of diverticulosis and diverticular disease, has been supported in the last few years by new imaging techniques, such as NMR and CT, that also find applications in the treatment of diverticulitis complications like peritoneal abscesses. Our emphasis is on the therapeutic perspective, either dietetic - based on the use of a fibre-rich diet and the infusion of liquids by intravenous injection - or surgical, such as the Hartmann procedure, single anastomosis with stomia conservation and laparoscopic and endoscopic treatment. These therapeutic approaches have reduced both morbidity and mortality rate and have emphasized how the reduction of surgical stress on the mesothelium promotes the recovery of the functional integrity and, consequently, faster resumption of peritoneal dialysis. In conclusion, diverticulosis alone is not a contraindication for peritoneal dialysis, but constitutes a risk factor for the continuation of this alternative treatment.

Implicaciones de la fibra en distintas patologías / Implications of fibre in different pathologies

Hace 3 décadas que las observaciones de Trowell y de Burkitt dieron origen a la “teoría de la fibra”, en la que se proponía que existía una relación entre el consumo de una alimentación alta en fibra y carbohidratos sin refinar y la protección frente a muchas de las enfermedades de países occidentales, como el estreñimiento, la diverticulosis, el cáncer de colon, la diabetes, la obesidad y las enfermedades cardiovasculares. A lo largo de estos años se han publicado numerosos trabajos que analizan la relación de la fibra con enfermedades del tracto gastrointestinal y otros procesos con implicaciones serias para la salud. En esta revisión se hace un repaso de la experiencia acumulada durante estos años sobre la importancia del consumo de la fibra en algunas patologías. No sólo por la relación epidemiológica que existe entre la ingestión de fibra y el desarrollo de enfermedades como el cáncer de colon o las enfermedades cardiovasculares, sino que se aborda el interés de la fibra como agente terapéutico, debido a los conocimientos actuales que se tienen sobre sus diferentes mecanismos de acción. Así, la posibilidad de emplear fibra soluble, ha visto renovado su interés para ser utilizado en el tratamiento de la enfermedad inflamatoria intestinal, para el control de las diarreas, en el síndrome del intestino irritable o para modular las concentraciones de glucemia o colesterol. Se comentan las discrepancias que existen entre el consumo de fibra y la enfermedad diverticular, el tratamiento del estreñimiento y la asociación con la obesidad y las enfermedades cardiovasculares. A pesar de las evidencias acumuladas en torno al consumo de fibra, las recomendaciones actuales sobre qué tipo de fibra consumir y cuál es la cantidad óptima están aún por definir. La ingestión de una elevada cantidad de fibra (> 25-30 g/día), a partir de diferentes fuentes alimentarias (frutas, verduras, legumbres, cereales) es la única manera de prevenir muchas de las enfermedades enumeradas. El consumo de un tipo determinado de fibra (soluble o insoluble) queda limitada al tratamiento de ciertos procesos, porque su relación individual con muchas enfermedades está aún pendiente de determinar (AU)

Three decades ago, the observations of Trowell and Burkitt gave rise to the “fibre theory”, in which it was contended that there was a link between the consumption of a diet rich in fibre and non-processed carbohydrates and the level of protection against many of the “first world diseases” such as constipation, diverticulosis, cancer of the colon, diabetes, obesity and cardiovascular disease. Since that time, numerous studies have been presented to analyze the relationship between fibre and disorders of the gastrointestinal tract and other processes with severe health implications. The present revision looks at the experience accumulated over this period regarding the importance of the consumption of fibre for certain phatologies. It not only deals with the epidemiological relationship existing between fibre intake and the development of diseases such as cancer of the colon or cardiovascular disorders but also reviews the interest of fibre a therapeutic agent, in view of the current information available on its different mechanism of action. Thus the possibility of using soluble fibre has taken on renewed interest for the treatment of inflammatory intestinal disease, for control of diarrhoea, in irritable bowel syndrome or no modulate the concentrations of glycaemia or cholesterol. Three is a discussion of the discrepancies found between the consumption of fibre and diverticular disease, the treatment of constipation and the association with obesity and cardiovascular disease. Despite the accumulated evidence on the consumption of fibre, there is currently no consensus as to recommendations on what type of fibre and the optimal amount that should be consumed. A high fibre intake (> 25-30 g/day) based on a variety of food sources (fruit, vegetable, legumes, cereals) is the only way to avoid many of the disorders mentioned. The consumption of a particular type of fibre (soluble or insoluble) is limited to the treatment of certain processes, because its individual relationship with many disorders is still pending determination (AU)

Benefits of dietary fiber. Myth or medicine?

In recent years, many health claims have been made about dietary and supplemental fiber. However, some reports (eg, those regarding oat bran) have been controversial. A review of scientifically rigorous studies shows that fiber has some preventive or therapeutic benefits in irritable bowel syndrome, diverticulosis, colorectal cancer, diabetes, and hypercholesterolemia. However, it appears to have no direct benefit in patients with inflammatory bowel disease, gallstones, or obesity. The United States has one of the lowest per capita intakes of fiber in the world. Therefore, increasing daily fiber intake either through diet or with supplements is recommended for most Americans. Consumer interest groups should lobby for more fiber-enriched foods. The challenge for education and healthcare professionals alike is to remold the nation's interest in and understanding of dietary fiber.

[Diverticulosis of the duodenum]. / Divertikulose des Duodenums.

A 62-year-old woman was admitted to hospital because of extremely severe colicky pain in the mesogastric region and vomiting. Six years earlier two duodenal diverticles had been found to be responsible for similar symptoms. Endoscopy and X-ray examination now revealed four extensive duodenal diverticles, the largest of which had an extension of 8 X 7 cm. There were no diverticular complications. The patient became free from complaints by conservative treatment, at first with "zero" diet, then with a regimen rich in dietary fibres and frequent small meals. She remained symptom-free during a follow-up period of six months so far.

Should we eat more fibre?

Controversy continues over the role of dietary fibre in health, and whether or not a standard fibre intake should be recommended for the UK. In this review an attempt is made to consider the evidence for and against making such a recommendation. In doing so, it is clear that many problems exist in studies examining the role of fibre in disease, such as the inherent inadequacies of epidemiological studies and distrust of such studies by some circles, or the lack of uniformity in definition of dietary fibre and in its chemical analysis. The effect of fibre on faecal bulking is given as an example of experimental verification of epidemiological findings which has led to the widespread use of fibre in treating diverticular disease and constipation. Evidence of beneficial effects for cancer of the colon and ischaemic heart disease are far less convincing. Few harmful effects of fibre have been documented, apart from continuing disagreement regarding fibre and mineral balance, a question which remains to be solved. On weighing the evidence, it is suggested that recommending higher-fibre intakes in the UK is a favourable guideline. The type of fibre to be recommended is discussed, based on new evidence of the mode of action of different types of fibre in the gastrointestinal tract, and the amount of fibre considered, in relation to intakes in other countries and in the past in the UK.