Advise patients to increase dietary fiber intake by generous consumption of fruits and vegetables, undertake regular physical activity, and maintain ideal body weight. There is no need for patients to avoid seeds, nuts, popcorn, or fruit skins. Increasing dietary fiber gradually may minimize bloating.[1]National Institute for Health and Care Excellence (UK). Diverticular disease: diagnosis and management. Nov 2019 [internet publication].
https://www.nice.org.uk/guidance/ng147
Patients should be counseled to quit smoking, and to lose weight if they are overweight or obese.[3]Hall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020 Jun;63(6):728-47.
https://journals.lww.com/dcrjournal/Fulltext/2020/06000/The_American_Society_of_Colon_and_Rectal_Surgeons.6.aspx
http://www.ncbi.nlm.nih.gov/pubmed/32384404?tool=bestpractice.com
[7]Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.
https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00313-4
http://www.ncbi.nlm.nih.gov/pubmed/32381121?tool=bestpractice.com
Advise patients to avoid nonsteroidal anti-inflammatory drugs (except aspirin for secondary prevention of cardiovascular disease) and opioids if possible, because they may increase the risk of diverticular perforation, complicated diverticulitis, and diverticular bleeding.[19]Shaikh A, Khrais A, Le A, et al. Pre-existing opioid use worsens outcomes in patients with diverticulitis. Cureus. 2023 Feb;15(2):e34624.
https://www.cureus.com/articles/135720-pre-existing-opioid-use-worsens-outcomes-in-patients-with-diverticulitis#!
http://www.ncbi.nlm.nih.gov/pubmed/36891029?tool=bestpractice.com
[20]Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019 Apr;156(5):1282-98.e1.
https://www.gastrojournal.org/article/S0016-5085(19)30046-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/30660732?tool=bestpractice.com
[36]Goh H, Bourne R. Non-steroidal anti-inflammatory drugs and perforated diverticular disease: a case-control study. Ann R Coll Surg Engl. 2002 Mar;84(2):93-6.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2503782
http://www.ncbi.nlm.nih.gov/pubmed/11995772?tool=bestpractice.com
[37]Stollman N, Smalley W, Hirano I; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015 Dec;149(7):1944-9.
https://www.gastrojournal.org/article/S0016-5085(15)01432-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26453777?tool=bestpractice.com
[38]Sugihara Y, Kudo SE, Miyachi H, et al. Analysis of risk factors for colonic diverticular bleeding: a matched case-control study. Gut Liver. 2016 Mar;10(2):244-9.
https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl14407
http://www.ncbi.nlm.nih.gov/pubmed/26087793?tool=bestpractice.com
[39]Yuhara H, Corley DA, Nakahara F, et al. Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis. J Gastroenterol. 2014 Jun;49(6):992-1000.
http://www.ncbi.nlm.nih.gov/pubmed/24221694?tool=bestpractice.com
[43]Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1.
https://www.gastrojournal.org/action/showPdf?pii=S0016-5085%2820%2935512-8
http://www.ncbi.nlm.nih.gov/pubmed/33279517?tool=bestpractice.com
[107]Longo S, Altobelli E, Castellini C, et al. Non-steroidal anti-inflammatory drugs and acetylsalicylic acid increase the risk of complications of diverticular disease: a meta-analysis of case-control and cohort studies. Int J Colorectal Dis. 2022 Mar;37(3):521-9.
http://www.ncbi.nlm.nih.gov/pubmed/35094111?tool=bestpractice.com