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Taylor Hughes
NURS 612
PICOT
5/1/2014

Do People With Diverticulitis, That Eat More Foods With High Fiber Content, Have
Less Flare-ups Compared to Those Who Eat Foods With Less Fiber Content?
Diverticulitis is a disease that involves the inflammation of the diverticulum that
lines the colon. There are two types on diverticulitis, uncomplicated and complicated.
Uncomplicated diverticulitis accounts for 75 percent of all cases and it refers to those
cases in which there is only microscopic perforation of the diverticulum. These patients
normally do not have complication related to the inflammation unlike the patients with
complicated diverticulitis, who suffer from issues such as obstructions, peritonitis,
abscesses, and fistulas (Young-Fadok 2014). Patients who have flare-ups and
inflammation experience symptoms of abdominal tenderness, bloating, fever, nausea, and
vomiting (Pemberton 2014). The diet of a patient with diverticulitis has been very
controversial over time. Some experts believe fiber intake does not contribute to
diverticulitis.
There are multiple studies to show that low fiber diets are a contributing factor to
the cause of diverticulitis. Knowing the most up to date evidence is important when
providing patients with education on their diets because diverticulitis accounts for
312,000 hospital admissions and 2.6 billion dollars each year in the United States (De
Korte 2011). Patient teaching in this population is a vital part of nursing and teaching
accurate information to help protect patients is even more important.
The databases searched included, MEDLINE, PubMed, CINAHL, and UpToDate.
The search engines used were EBSCO HOST and Elsevier. Key words included,
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diverticulitis, diet, fiber, high fiber, diverticulum, and inflammation. Limits
included full text and Language: English. In CINHAL 8 citations were identified, in
PubMed 40 citations were identified, in MEDLINE 6 citations were identified, and in
UpToDate 13 citations were identified. Three articles from the review of literature were
selected; they were further analyzed to find the best evidence on the consumption of fiber
in patients with diverticulitis. Inclusion criteria in the selected three articled included,
patients being 18 years or older, having the diagnosis of uncomplicated diverticulitis,
having had at least one episode of acute diverticulitis, and having had the diagnosis be
confirmed by barium enema, colonoscopy, or CT scan. Exclusion criteria included
patients with complicated diverticulitis, patients who had coexisting gastrointestinal
disorders, and patients who were asymptomatic.
In the article, High fiber diet in symptomatic diverticular disease of the colon,
the researchers compared high fiber and non-high fiber diets. High fiber diets included
the consumption of 25 gm or more of fiber per day and non-high fiber diets included less
than 25 gm of fiber per day. This study had two groups; a group of 43 patients who were
advised to follow a high fiber diet and another group of 13 patients who were not advised
to follow a high fiber diet. During a follow up visit, 31 of the 43 patients had adhered to
the high fiber diet. This made up the high fiber group making this group have a total of
31 patients. Of the 13 patients who were not given information on high fiber diets none
had been known to be following a high fiber diet. Along with these 13 patients, the 12
patients that did not adhere to the high fiber group became apart of the non-high fiber
group making this group have a total of 25 patients. These two groups of patients were
followed over 54-76 months (Leahy 1985).
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The results of these studies were that of the 31 patients in the high fiber group 2
patients (6.5%) were re-admitted with complications of diverticulitis. In the non-high
fiber group 5 of the 25 patients (20.0%) were re-admitted with complications of
diverticulitis. On later follow ups 6 of the 22 (27.3%) remaining patients in the high fiber
group were symptomatic compared to the 11 of the 16 (68.8%) remaining patients in the
non-high fiber group (Leahy 1985). These results lead people to believe that high fiber
diets help control the symptoms of diverticulitis.
The strengths of this study were that there was little room for bias. The patients
were blinded to the group that they were in which allowed for the results to not be
skewed by participants. Another strength of this study was the length of time that is was
performed over. This allowed for the results to be a good depiction of how fiber affects
patients with diverticulitis. The weaknesses of this study included the small sample size,
which could lead to false assumptions about the importance of high fiber diets in patients
with diverticulitis. Another weakness of this study was the lack of randomization in each
group.
In the article, Are fiber supplements really necessary in diverticular disease of
the colon, the researches compared 3 types of fiber treatments on patients with
uncomplicated diverticulitis. One treatment was the ingestion of bran biscuit for 16
weeks; this biscuit had 6.99 gm of fiber/day. The second treatment was an ispaghula
drink that was taken for 16 weeks; this had 9.04 gm of fiber/day. The third treatment was
a placebo that was taken for 16 weeks; this had 2.34 gm of fiber/day. There were a total
of 22 men and 36 women enrolled in this study. All of these participants were unaware of
which treatment they were receiving. Each participant went through the three different
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treatment groups at different times. A dietitian assessed each participants base line fiber
intake at the start and end of the trial. Monthly questionnaires with 12 questions were
given to each participant to track their symptoms. At the end of the 16 weeks each
participant was asked to collect their stool for seven days to assess for stool weight and
frequency. Pain, lower bowel symptoms, and overall symptoms were given a score based
on the questionnaires completed monthly (Ornstein 1981).
The results of this study were that there was no statistical difference in pain scores
in each of the three treatment groups. However, patients in the ispaghula treatment phase
had significant improvement in their symptoms of constipation compared to the bran
crisp phase and the placebo phase (Ornstein 1981). These results showed that increase in
fiber does not affect diverticulitis symptoms but it does decrease the symptoms of
constipation.
The strengths of this study were that it was a double blind experiment. This limits
the amount of bias in the results. The other strength of this study was participants were
unaware of when they were switching treatments, which also allowed for minimal bias in
the answering of the monthly questionnaires. The weaknesses of this study included the
small sample size, which could lead to false assumptions about fiber intake and the
contribution to diverticulitis symptoms. Another weakness could be the questionnaires
given, the researchers made their own questionnaire. This can lead to researcher bias
because they could have formulated the questions in a way that would give them the
results they wanted.
In the article, Low-Reside diet in diverticular disease: putting an end to a myth,
the researchers followed 18 symptomatic participants that were diagnosed with
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diverticulitis over 3 months. The 18 people were randomly assigned to one of two groups.
One group of 9 people received bran crisp bread that had 6.7 gm of fiber/day. The other
group of 9 people received wheat crisp bread that had 0.6 gm of fiber/day. Each
participant answered a standardized symptom questionnaire each month for three months.
The results of this study showed that the people in the bran crisp bread group had
significantly greater pain relief and decreased symptoms of diverticulitis over the 3-
month period. However, there was no significant difference in bowel habits between the
two groups (Tarleton 2011).
The strengths of this study were the randomization of the two groups. This
allowed for limited bias when participants answered the questionnaire. The weakness of
this study is the small sample size and the short period over which the study was
performed. This could allow for false assumptions about the intake of fiber and the
control of symptoms involved with diverticulitis.
Based off of these three articles there are still some discrepancies in whether or
not high fiber diets relieve symptoms of diverticulitis. Two of the three articles showed
that increases in fiber decrease symptoms associated with diverticulitis. The third article
did not show a decrease in symptoms between increased intakes of fiber but it did show
improvement in constipation with increased intake of fiber. There was a consistent
limitation between all three studies with small sample sizes. This limitation does not
allow for these results to be generalized to all patients with diverticulitis. Overall the
participants in the three studies had some sort of decrease in their symptoms associated
with their diverticulitis.
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I believe that when it comes to patient teaching about diets and managing
diverticulitis symptoms nurses should advocate for patients to increase their intake of
fiber. Although the evidence is still inconsistent if increased fiber does or does not
decrease symptoms of diverticulitis, fiber will not hurt the patient. Fiber helps promote
bowl motility, lessens episodes of constipation, and possibly helps decrease symptoms of
diverticulitis. Therefore I believe that there are only positive benefits from increasing
fiber intake and whether or not it helps diverticulitis symptoms it certainly will not
worsen these symptoms.
I do however believe that more research is needed on different diets and
diverticulitis management. Most of the studies that I found were older and the results
were not clear on what to recommend to patients. With 312,000 hospital admissions each
year due to diverticulitis flare-ups, I believe we need more research to help teach this
population of patients on how to manage their symptoms with diet changes. This number
of hospital admissions is very large and could possibly be reduced drastically if there was
clearer evidence on the best diet for these patients to follow.








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References
De Korte, N., Klarenbeek, B. R., Kuyvenhoven, J. P., Roumen, R. M. H., Cuesta, M. A.,
& Stockmann, H. B. A. C. (2011). Management of diverticulitis: Results of a
survey among gastroenterologists and surgeons. Colorectal Disease: The
Official Journal of the Association of Coloproctology of Great Britain and
Ireland, 13(12), e411-e417. doi:10.1111/j.1463-1318.2011.02744.x

Leahy, A., Ellis, R. ,Quill, D., & Peel, A. (1985). High Fiber diet in symptomatic
diverticular disease of the colon. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2498056/pdf/annrcse0153 2-
0037.pdf

Orenstein, M., Littlewood, E., Baird, I., Fowler, J., North, W., & Cox, A. (1981). Are
Fiber Supplements Really Necessary in Diverticular Disease of the Colon.
Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1505006/pdf/bmjcred0065 5-
0019.pdf

Pemberton, J., & Young-Fadok, T. (2014, April). Clinical Manifestations and Diagnosis
of Acute Diverticulitis in Adults. Retrieved from
http://www.uptodate.com.libproxy.unh.edu/contents/clinical-
manifestations-and-diagnosis-of-acute-diverticulitis-in-
adults?source=machineLearning&search=diverticulitis+symptoms&selected
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Tarleton, S., & DiBaise, J. (2011 March). Low Residue Diet in Diverticular Disease:
Putting an End to a Myth. Retrieved from
http://ncp.sagepub.com.libproxy.unh.edu/content/26/2/137.full.pdf+html

Young-Fadok, T., & Pemberton, J. (2014, February). Treatment of Acute Diverticulitis.
Retrieved from
http://www.uptodate.com.libproxy.unh.edu/contents/treatment-of-acute-
diverticulitis?source=machineLearning&search=diverticulitis&selectedTitle=
1%7E16&sectionRank=1&anchor=H3#H3