Study says aggressive treatment for diverticulitis is often overused

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Chatting about your diverticulitis isn’t exactly party talk. This unpleasant condition, which occurs when tiny pouches inside the large intestine become inflamed, can cause intense lower abdominal pain, diarrhea, constipation, a fever, and sometimes a good deal of rectal bleeding. Following a liquid diet for a while can help treat diverticulitis, but antibiotics, and sometimes even surgery, may be needed. A few years ago, a study published in The Journal of the American Medical Association found that hospital admissions for elective surgery for diverticulitis had increased 25% to 30% and that surgery for diverticulitis may was likely overused.

The researchers reviewed the results of 80 studies of diverticulitis and its treatment. While the team agreed that antibiotic use and surgery are sometimes necessary for diverticulitis, it concluded that there should be a lesser role for aggressive antibiotic or surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary.

“I’d be loath to say don’t give antibiotics to patients with diverticulitis. It depends if they have clear cut diverticulitis accompanied by pain, fever, elevated white blood cell count, and an abnormal physical exam. You have to see if they have these findings,” says Dr. Norton Greenberger, a gastroenterologist and professor of medicine at Harvard Medical School. “If these are absent, the patient may have just symptomatic diverticular disease.”

“Likewise, some people need surgery, especially if they’ve had two episodes of diverticulitis in a six-month period,” says Dr. Greenberger. He feels the study isn’t clear on how many people who received surgery had recurring bouts of diverticulitis.

In other words, treatments for diverticulitis need to be individualized.

It’s also helpful to learn more about diverticulitis, because, while not entirely common, it happens to be the end stage of a common condition known as diverticulosis, which a third of all American adults have and likely don’t even realize.

You have diverticulosis if you have diverticula, pouch-like structures that form in the muscular wall of the colon. They’re usually harmless. In some people, though, the pouches become inflamed and infected (called diverticulitis), or they may bleed.

How often does diverticulosis morph into diverticulitis? Thankfully, not often. A recent study in Clinical Gastroenterology and Hepatology found that it happens only about 4% of the time. That contradicts prevailing thinking that 10% to 25% of people with diverticulosis go on to develop diverticulitis.

We don’t know who will develop diverticulitis or a diverticular bleed, but there are some factors that increase the odds of that happening. One is age: 70% of people age 80 and older have the condition. Other risk factors include obesity, a lack of exercise, and a diet low in fiber.

Will exercising, controlling your weight, and eating a high-fiber diet prevent diverticular disease? Possibly, but there isn’t yet convincing proof of it. But we do know that diet plays an important role in colon health. It brings relief from constipation, better cholesterol control, and makes for more filling meals that help you maintain a healthy weight.

How much fiber should you aim for? Adults should get 25 to 30 grams of dietary fiber every day. It’s best to get it from high-fiber foods, such as beans, whole grains, vegetables, and fruits. If you can’t get that amount from food, talk with your doctor or a nutrition professional about taking a fiber supplement. Add the fiber gradually, since adding it to your diet too fast can cause gas and bloating.

Sugar is another big culprit. It plays a part in symptomatic diverticular disease and may mimic irritable bowel syndrome. “I can’t tell you how many patients with irritable bowel drink two to three cans of cola a day,” says Dr. Greenberger.

More fiber can also bring relief to a condition with symptoms similar to diverticulosis and diverticulitis called myochosis, which is part of the spectrum of diverticular disease. It’s a thickening of the circular and longitudinal muscle layers of the colon and is often responsible for lower abdominal pain, passage of pencil thin stools, and pain with defecation.

Dr. Greenberger points to other foods and drinks that can cause problems in people with underlying diverticular disease and irritable bowel, which have overlapping symptoms. These include:

• asparagus
• broccoli
• Brussels sprouts
• cabbage
• cherries
• cola beverages
• foods and drinks with added sugar (including syrup and orange juice)
• dairy products
• nuts
• peaches
• pears

You can read more about improving digestive health in Dr. Greenberger’s book, 4 Weeks to Healthy Digestion: A Harvard Doctor’s Proven Plan for Reducing Symptoms of Diarrhea, Constipation, Heartburn, and More, or in The Sensitive Gut, a Special Health Report from Harvard Medical School.

Both publications can help you feel better. And that will give you something to talk about at your next party.