Diverticulitis is common in 50 percent of adults over 60; it’s a poorly understood disease but it seems anti-inflammatory compounds from friendly gut bacteria may be the way forward.
Diverticular disease is defined as an infection in the tiny pouches of the colon. The pouches are called diverticula (1). These pouches bulge outwards through weak spots in the colon wall. In fact, not all cases are due to infection – the pouches can become inflamed (red and swollen) or infected.
- Diverticulitis is when there is infection.
- Diverticulosis is an inflammatory illness and can be asymptomatic.
One of the main contributory factors is felt to be a low fibre diet and constipation resulting in food blockages pushIng the pouches outwards. More than half of adults in the USA over the age of 60 have diverticular disease. The disease is increasingly common in countries such as Australia and the UK. The disease is more common in males, those who are obese, and those who take little exercise. Smoking and NSAIDs are also linked to the disease, as is poor motility (the ability to move food through the gut).
Symptoms involve cramping, abdominal pain, wind, and the disease is often confused with IBS at first. In some cases patients can sleep poorly and develop a fever.
People with acute diverticulitis are often treated with antibiotics and pain medications, although if there is a rupture, hospitalisation and even surgery may be required. Steroids like Prednisolone, when taken where someone has diverticular disease (for example, asymptomatic disease) can cause perforations in their diverticula, leakage of bacteria into the surrounding tissues and infection.
A Colonoscopy can be used to see the extent of the illness but cannot be used in severe cases as it may cause perforations.
The Gut microbiome and diverticulitis
Early studies (2) suggested that Diverticular disease might well be associated with reduced representation of bacteria that have an anti-inflammatory benefit, such as Clostridium cluster IV, and an overgrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia.
However a 2021 study with 43 patients suggested people with asymptomatic disease do not have different microbiomes to healthy individuals (3). However, in a 2022 study (4) with patients who had acute diverticulitis, researchers from Rome led by Professor Veronic Ojetti showed that using bacterial strains that had anti-inflammatory benefits, had a significant effect and were better than antibiotics. They also showed that acute diverticulitis was associated with lowered levels of bacteria that had anti-inflammatory benefits and higher levels of bacteria than produced inflammatory chemicals. This fuels gut wall mucosal inflammation.
This study was backed up by a second and both concluded that the bacterium L. reuteri ATCC PTA 4659 at a dose of 5 x 108 colony-forming units for 10 days might help manage acute uncomplicated diverticulitis and reduce hospitalisation periods without the use of antibiotics (5).
Diverticulitis – the bottom line
It is early days yet, but the use of antibiotics may be doomed; even Faecal transplants have been showing results.
We also recently reviewed Colitis and showed that there was research that each of Butyrate (an anti-inflammatory compound made by the Ruminococcus family), Serrapeptase, Boswellia and oral Aloe vera were effective in less that 4 weeks at calming and healing the gut wall. In some of the studies, both Colitis and Diverticulitis were mentioned. These compounds promoted the numbers of bacteria known to have anti-inflammatory effects.
It is also worth pointing out that standard high street probiotics are largely comprised of Lactic Acid strains and may not be directly helpful. Clearly though, specific anti-inflammatory gut bacteria along with compounds that can promote their numbers may be the best way forward in this poorly researched area.
- Johns Hopkins Medicine; Diverticular disease – https://www.hopkinsmedicine.org/health/conditions-and-diseases/diverticular-disease
- Diverticular Disease: a Gut Microbiota Perspective; Andrea Ticinesi et al; J Gastrointestin Liver Dis; 2019 Sep 1;28(3):327-337;
- Microbiota composition and mucosal immunity in patients with asymptomatic diverticulosis and controls; Tessel M van Rossen et al, PLoS One, 2021 Sep 7;16(9):e0256657.
- Randomized control trial on the efficacy of Limosilactobacillus reuteri ATCC PTA 4659 in reducing inflammatory markers in acute uncomplicated diverticulitis; Veronica Ojetti et al, Euro J Gastroenterol Hepatol 2022 May 1;34(5):496-502
- Probiotics with an anti-inflammatory effect may reduce abdominal pain and hours of hospitalization in adult patients with acute uncomplicated diverticulitis; Gut Microbiota for Health