The Role of Fiber in Diverticular Disease

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CME Learning Objectives:On completion of this educational activity, learners will be better able to: (1) Identify the various classifications of fiber. (2) Understand the role of fiber and its effect on the colonic environment. (3) Be aware of current fiber recommendations in diverticular disease.Diverticular disease is viewed, by most physicians, as a consequence of a diet which consumes inadequate amounts of fiber. Dietary fiber helps form large bulky stool, resulting in a larger radius colon that is less likely to permit segmentation and therefore less likely to develop diverticula. Although as many as two-thirds of individuals in the west have diverticular disease by the age of 85 years, perhaps only 10% to 25% will manifest any related clinical symptoms. What distinguishes individuals who progress to symptomatic disease is still uncertain. Recent studies suggest that the natural history of diverticular disease bears many similarities to that of chronic inflammatory bowel disease. Some of the cellular mechanisms that underlie the development of chronic inflammation and inflammatory complications may be common to both diverticulitis and inflammatory bowel disease. The impact of decreased fiber has been explored largely as having physiological effects in decreasing transit time and increasing intracolonic pressure. Fiber has benefits both as a preventative measure not only by bulking stool but also due to its effects on colonic microflora and also as a treatment for symptomatic diverticular disease. The decrease in soluble fiber in our diets may have altered our gut flora, which may have significant immune consequences central to the pathophysiology of diverticulitis. This study aims to review the potential contribution of different types of fiber to the development of diverticular disease, the relationship between fiber and diverticular disease as both a preventative measure and a treatment as well as its potential influence on colonic flora with speculation on possible neglected areas of importance still left unanswered.

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