Symbiotics, Probiotics, and Fiber Diet in Diverticular Disease

Diverticular disease is a common gastrointestinal condition in the Western world with the highest rates in the United States and Europe. The clinical spectrum ranges from diverticulosis without symptoms to symptomatic uncomplicated, or complicated diverticular disease. Symptoms related to uncomplicated diverticular disease are not specific and may be indistinguishable from those of irritable bowel syndrome as vague abdominal pain or discomfort, abdominal bloating, or changes in bowel habit. In symptomatic uncomplicated diverticular disease, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as potential contributing factors to symptoms. Even though the pathogenesis and management of diverticulosis and diverticular disease still remain uncertain for several aspects, new hypotheses and observations are changing how to treat diverticular disease to improve symptoms and prevent potentially serious complications. Probiotics, prebiotics, and synbiotics may modify the gut microbial balance leading to health benefits. Changes in peridiverticular bacterial flora have been suggested as playing a role in generating abdominal symptoms in diverticular disease. Thus, probiotics and synbiotics are promising treatment options for this condition. The rationale for the use of probiotics or synbiotics in diverticular disease is given by their anti-inflammatory effects and by maintaining an adequate bacterial colonization in the gastrointestinal tract. High-fiber diet is largely suggested for patients with symptomatic uncomplicated diverticular disease patients. Dietary fiber intake provides many health benefits. In the colon, fermentable dietary fiber may act as prebiotic to promote healthpromoting species of the intestinal microbiota. Insoluble fibers are especially effective in increasing fecal mass and promoting regularity of bowel movements. Although the widely believed idea that colonic diverticula are the result of a low-fiber diet has been challenged, there is some evidence that a high-fiber diet may protect against diverticular disease. This chapter focuses on the use of prebiotics, synbiotics, and dietary fiber in uncomplicated diverticular disease, because complicated diverticular disease as acute diverticulitis requires other treatment options such as oral or parenteral antibiotics and in some cases, surgery and is beyond the purpose of this work.