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The use of dietary fibre manipulation, probiotics and antibiotics have been hypothesised to benefit the management of diverticular disease. However, dietary recommendations for the prevention of diverticulitis are inconsistent and quality evidence is lacking. This systematic review aimed to pool and appraise existing data to give recommendations for dietary fibre modifications with or without probiotics and/or antibiotics in adults for the prevention of diverticulitis.
Five electronic databases were searched for studies from database inception until March 2017. Studies were critically appraised and pooled using meta analysis and overall quality of evidence was reviewed using GRADE to make recommendations.
A long-term high dietary fibre intake (meeting or exceeding the nationally recommended intake for gender and age) after an acute episode of uncomplicated diverticulitis has resolved is recommended to prevent reoccurrence (strong recommendation based on very low-quality evidence). In adults with diverticular disease and no previous history of diverticulitis, insufficient research exists to make recommendations for the use of dietary fibre alone to prevent diverticulitis. Co-administration of dietary fibre with antibiotics appears to have superior effects compared to dietary fibre supplementation alone; however, recommendations for this are not supported in this review due to the high risk of bias in existing research.
Further well conducted randomised controlled trials are required to strengthen recommendations.