High-fiber diet for diverticular disease may be the historical narrative?



 

What is the basis for the theory that high-fiber diet is effective in diverticular disease (DD)?

That was the reason that the DD was not found in the race of the short transit time.

Then, prevention of constipation was considered most important diet for DD.

However, that was not fact.

In the DD patients, diarrhea was often rather than constipation.

 

Int J Surg. 2015 Jul;19:42-5. doi: 10.1016/j.ijsu.2015.04.045. Epub 2015 May 15.

Constipation is not associated with diverticular disease - Analysis of 976 patients.

Braunschmid T¹, Stift A¹, Mittlböck M², Lord A³, Weiser FA⁴, Riss S⁵.

Author information

·         ¹Medical University of Vienna, Department of Surgery, Austria.

·         ²Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Austria.

·         ³Southampton University Hospital, UK.

·         ⁴Endoscopic Center, Anton-Baumgartner-Straße 44, 1230 Vienna, Austria.

·         ⁵Medical University of Vienna, Department of Surgery, Austria. Electronic address: stefan.riss@meduniwien.ac.at.

Abstract

BACKGROUND:

In the light of controversial data in the literature, the present study was designed to evaluate potential associations between colonic diverticular disease, constipation and quality of life.

DESIGN:

We prospectively enrolled 976 consecutive patients, who participated in the nationwide colorectal cancer screening program in four medical centers between 2008 and 2009. All patients underwent full colonoscopy and completed a standardized questionnaire. The severity ofconstipation was assessed by the validated Wexner constipation score. Quality of Life (QOL) was evaluated by the SF-12 health score.

RESULTS:

The median age was 62 years (range 22-90) and the male to female ratio was 1:1. Colonic diverticular disease was found in 290 participants (30%). Age, body mass index and diabetes mellitus were significantly associated with the presence of diverticular disease (p < 0.0001, p = 0.0007 and p = 0.0178). The median constipation score in patients with diverticular disease was 3 (range 0-18), and comparable to patients without diverticula (p = 0.1073). The physical component summary of the SF-12 was significantly reduced in patients with diverticular disease (p = 0.0038).

CONCLUSION:

This large population based study revealed no association between colonic diverticular disease and constipation. Notably, the presence of diverticular disease significantly impacts quality of life.

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Järbrink Sehgal ME, Andreasson A, Talley NJ, Agréus L, Song JY, Schmidt PT. Symptomatic diverticulosis is characterized by loose stools.

Clin Gastroenterol Hepatol. 2016 Jun 21. pii: S1542-3565(16)30318-4.

Clin Gastroenterol Hepatol. 2016 Jun 21. pii: S1542-3565(16)30318-4. doi: 10.1016/j.cgh.2016.06.014. [Epub ahead of print]

Symptomatic Diverticulosis Is Characterized By Loose Stools.

Järbrink Sehgal ME¹, Andreasson A², Talley NJ³, Agréus L⁴, Song JY⁵, Schmidt PT⁶.

Author information

·         ¹Department of Medicine Solna, Karolinska Institutet, Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden; Department of Gastroenterology, Baylor College of Medicine, Houston, Texas. Electronic address: ellionore.jarbrink@ki.se.

·         ²Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.

·         ³Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.

·         ⁴Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden.

·         ⁵Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden; Division of Gastroenterology, Department of Internal Medicine, Leechuntek Hospital, Suwon, Korea.

·         ⁶Department of Medicine Solna, Karolinska Institutet, Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden.

Abstract

BACKGROUND & AIMS:

Symptomatic uncomplicated diverticular disease is considered to be a discreet clinical entity distinct from irritable bowel syndrome (IBS), but population-based data are unavailable. We aimed to investigate the prevalence and location of diverticulosis in the general population, and its association with colonic symptoms and mental health. We propose that individuals with diverticulosis would report more constipation and IBS.

METHODS:

We performed a population-based study of randomly selected adults born in Sweden (age, 18-70 y; 57.2% women); 745 received a gastroenterology consultation, completed validated abdominal symptom and mental health questionnaires, and were examined by colonoscopy. Logistic regression was used to calculate the associations between diverticulosis and age, sex, gastrointestinal symptoms, anxiety, depression, and self-rated health.

RESULTS:

Among the 742 participants (54.6% women), 130 (17.5%) had diverticulosis. Age was the strongest predictor of diverticulosis (P < .001), and diverticulosis was rare in participants younger than 40 years (0.7%). All participants with diverticulosis had sigmoid involvement. Participants with diverticulosis were more likely to report loose stools (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.20-2.96), urgency (OR, 1.64; 95% CI, 1.02-2.63), passing mucus (OR, 2.26; 95% CI, 1.08-4.72), and a high stool frequency (OR, 2.02; 95% CI, 1.11-3.65). Diverticulosis was associated with abdominal pain (OR, 2.10; 95% CI, 1.01-4.36; P = .047) and diarrhea-predominant IBS (OR, 9.55; 95% CI, 1.08-84.08; P = .04) in participants older than 60 years. The presence of anxiety and depression and self-rated health were similar in participants with and without diverticulosis.

CONCLUSIONS:

The prevalence of diverticulosis is age-dependent. Diverticulosis is associated with diarrhea in subjects across all age ranges. In subjects older than age 60, diverticulosis is associated with abdominal pain and diarrhea-predominant IBS.