title: A systematic review of high-fibre dietary therapy in diverticular disease.
abstract: OBJECTIVE
  The exact pathogenesis of diverticular disease of the sigmoid colon is not well established. However, the hypothesis that a low-fibre diet may result in diverticulosis and a high-fibre diet will prevent symptoms or complications of diverticular disease is widely accepted. The aim of this review is to assess whether a high-fibre diet can improve symptoms and/or prevent complications of diverticular disease of the sigmoid colon and/or prevent recurrent diverticulitis after a primary episode.
  
  
  METHODS
  Clinical studies were eligible for inclusion if they assessed the treatment of diverticular disease or the prevention of recurrent diverticulitis with a high-fibre diet. The following exclusion criteria were used for study selection: studies without comparison of the patient group with a control group.
  
  
  RESULTS
  No studies concerning prevention of recurrent diverticulitis with a high-fibre diet met our inclusion criteria. Three randomised controlled trials (RCT) and one case-control study were included in this systematic review. One RCT of moderate quality showed no difference in the primary endpoints. A second RCT of moderate quality and the case-control study found a significant difference in favour of a high-fibre diet in the treatment of symptomatic diverticular disease. The third RCT of moderate quality found a significant difference in favour of methylcellulose (fibre supplement). This study also showed a placebo effect.
  
  
  CONCLUSIONS
  High-quality evidence for a high-fibre diet in the treatment of diverticular disease is lacking, and most recommendations are based on inconsistent level 2 and mostly level 3 evidence. Nevertheless, high-fibre diet is still recommended in several guidelines.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. c.unlu@slaz.nl
authors.forename: Cagdas
authors.initials: C
authors.lastname: Ünlü
authors.forename: Lidewine
authors.initials: L
authors.lastname: Daniels
authors.forename: Bart C
authors.initials: BC
authors.lastname: Vrouenraets
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D004043:Dietary Fiber / Q000627:therapeutic use*; D004240:Diverticulum / Q000178:diet therapy* / Q000517:prevention & control; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence