Instrua os pacientes a aumentarem a ingestão alimentar de fibras através de um consumo generoso de frutas e vegetais, bem como a realizarem atividades físicas regulares e manterem um peso corporal ideal. Não há necessidade de os pacientes evitarem sementes, nozes, pipoca ou cascas de frutas. Aumentar gradualmente a ingestão alimentar de fibras pode minimizar a distensão abdominal.[1]National Institute for Health and Care Excellence. Diverticular disease: diagnosis and management. Nov 2019 [internet publication].
https://www.nice.org.uk/guidance/ng147
Os pacientes devem ser aconselhados a abandonar o hábito de fumar e a perder peso se estiverem com sobrepeso ou obesos.[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
Aconselhe os pacientes a evitarem os anti-inflamatórios não esteroidais (exceto aspirina para prevenção secundária de doenças cardiovasculares) e os opioides, se possível, porque eles podem aumentar o risco de perfuração diverticular, diverticulite complicada e sangramento diverticular.[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
[105]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