Some years ago I wrote a short review article on fibre and diverticular disease so I read with interest a recent article in the British Medical Journal on treating diverticular symptoms with fibre.
Whilst we know that a low fibre intake is associated with an increased risk of developing diverticulosis, there isn’t any good evidence that treating symptomatic diverticular disease with fibre is of benefit.
The article highlights the lack of scientific evidence and points out that it is unlikely that there will ever be any industry lead trial of fibre supplementation, as fibre would not be patentable.
There is however, growing interest from companies in looking at other treatments that alter gut bacteria or immunology.
Trials are currently underway looking at an anti-inflammatory drug, mesalazine, in treating symptomatic diverticular disease and also for preventing acute diverticulitis as well as studies of Lactobacillus in uncomplicated diverticular disease. The results of these trials may lead to some new treatments for diverticular disease.
In the meantime, I agree with the conclusions of the authors.
It is always important to let patients understand the lack of evidence around treatments for diverticular disease and fibre in particular.
Fibre can be beneficial for patients, in particular relieving constipation but it is important to warn them that it can also increase flatulence and can sometimes exacerbate pain. If patients are already taking a high fibre diet it can be beneficial for them to reduce their fibre intake a little. This strategy certainly works well for irritable bowel sufferers already on a high fibre diet.
Obesity has been associated with increased risk of symptoms from diverticular disease, a high fibre diet in the overweight patient may well help them lose weight as well as providing symptomatic relief.
It is likely that fibre supplementation will continue to be helpful for many, together with the promising new treatments currently being evaluated.
SimonRadley July 2012