Diverticulitis: what it is and advice on diet

What’s this?

Intestinal diverticulitis is one rather frequent disease in the western population.

Between the causes there is a low-fiber diet, constipation and obesity. It is estimated that 30-40% of patients undergoing instrumental investigations of the digestive system present diverticula in the large intestine. 75% of these are completely asymptomatic. For this reason it is more correct to speak of diverticulosis to indicate the presence of diverticula and diverticulitis if symptoms appear. In some cases one inherits it from one’s parents structural weakness of the colon walls and this congenital defect makes the onset of the pathology even more probable. But what are diverticula? These are sack-shaped formations that are located in points of the intestine characterized by less resistance. The risks associated with this condition are infection, obstruction and perforation.

Inflammation of the diverticula it may represent a medical emergency which in some cases puts the patient at risk of life. Numerous scientific evidences recognize that at the base of the inflammation of the diverticula there can be an alteration of the intestinal bacterial flora with consequent loss of good bacteria (probiotics) and increased proliferation of potential pathogens (pathogens). This condition is referred to as intestinal dysbiosis. The most up-to-date scientific evidence shows that dysbiosis leads to the activation of the immune system with the consequent release of pro-inflammatory molecules. Therefore, maintaining the right balance between probiotics and pathogenic bacteria opportunists allows to keep inflammation at bay even at the level of the diverticular sacs.

Symptoms

Patients with diverticula can be completely asymptomatic, may present forms of diverticulitis minimally symptomatic or may lead to forms of acute diverticulitis with sudden abdominal pain and fever. In this case, immediate hospitalization of the patient is required and surgical treatment is most often necessary. The complications most frequently associated with diverticulitis are:

• diverticular hemorrhage;
• diverticular abscess;
• perforation of the diverticulum;
• fistulas that form between the colon and the bladder;
• bowel obstruction.

Causes

Between main causes that lead to the formation of diverticula there are:

• poor fiber intake: the consequent reduction of the fecal mass slows down the transit and leads to an increase in pressure inside the intestinal lumen; the colon wall is therefore subjected to an increased pressure stress which leads to the formation of diverticular sacs;
• constipation: following the increased effort exerted during defecation, the intraluminal pressure will further increase;
• age: with the passing of the years, the degeneration of the proteins that give structure to the connective tissue (collagen and elastin) causes a further weakening of the colon wall;
• obesity: the abundant fat present inside the abdominal cavity (visceral fat) ends up compressing the colon so as to reduce its distensibility; this phenomenon also leads to an increase in intraluminal pressure;
• genetic predisposition: the finding of a familiarity due to diverticular disease is frequent.

The diagnosis

Colon diverticulitis is diagnosed as follows:

• laboratory tests documenting the increase in inflammatory markers (high sensitivity PCR or PCRhs and ESR);
• CT scan of the complete abdomen with contrast medium;
• virtual colonoscopy that is performed by means of a latest generation spiral CT scan;
• traditional colonoscopy;
• ultrasound of the abdomen.

Importance of fibers

Dietary fiber does not have the sole effect of increasing fecal mass. It is precisely starting from dietary fiber, in fact, that the intestinal microbial flora produces butyric acid, propionic acid and acetic acid, or molecules better known as short-chain fatty acids (SCFAs, Short Chain Fatty Acids) and able to interact with specific receptors (GPR41 and GPR43) by stimulating the release of peptides that promote intestinal motility (peristalsis). Butyric acid also has the role of nourishing the cells that line the colon (colonocytes) and has a powerful anti-inflammatory and anti-neoplastic action. The problem is that those suffering from diverticula have the distinct feeling of not tolerating fiber-laden meals. We are inside a perverse loop because if it is true that the attitude a consume few vegetables is one of the causes of diverticulitis, once the diverticula have appeared there is a tendency to consume less and less fiber. The secret, as always, lies in the right middle ground.

Role of probiotics in prevention

The priority is to treat intestinal dysbiosis while suggesting one proper diet. The intake of selected probiotic bacterial strains is able to reduce the presence of pathogenic bacterial flora and to restore eubiosis (term with which we refer to the right balance between good bacteria and potential pathogens).

Probiotics make life difficult for pathogens through the synthesis of substances with an antibiotic-like action (bacteriocins). Numerous studies document, for example, the ability of Enterococcus faecium to inhibit the proliferation of opportunistic and pathogenic bacteria by means of a numerical overwhelming mechanism and thanks to the production of specific bacteriocins. Saccharomyces boulardii is a micromycete able not only to counteract the proliferation of pathogenic bacteria but also that of Candida albicans, another possible cause of intestinal inflammation.

What to avoid

They are to be avoided:

• vegetables with very leathery fibers (for example chicory, artichokes, celery) unless they are pureed;
• the berries and fruits containing seeds;
• whole grains;
• solanaceae (tomatoes, aubergines, peppers);
• the spices which may have an irritating action on the mucosa.

In this way we want to avoid the fact that some residue ends up inside the diverticular sac, resulting in inflammation.

Adequate diet

For what has been said so far, the presence of diverticula should not impose a low-fiber diet. It is important, however, especially in the presence of symptoms, reduce the amount of insoluble fibers (cellulose, hemicellulose, lignin) contained in whole grains, leafy vegetables and some vegetables. The soluble fibers, more represented in fruit, have a lower risk of creating complications in those suffering from diverticulitis.

To ensure that the physiological production of butyric acid can take place in the large intestine, while having to modulate the amount of fiber, it may be useful to include the diet in theretrograded starch, also known as resistant starch. It is that fraction of starch, made up of 100% amylose, which resists the action of digestive enzymes. However, the bacteria that live in the colon take care of degrading the resistant starch. The fermentation of starch by colic bacteria leads to production of the aforementioned short-chain fatty acids with all the ensuing advantages. Where can resistant starch be found? In stale bread, in unripe bananas, in potatoes first boiled and then left to cool, in raw potato starch.

Finally, the insertion of lacto-fermented vegetables (see sauerkraut) can be beneficial not only because they are foods already partially digested by the action of the bacteria that operate the fermentation but also because, following their habitual consumption, a good share of these bacteria ends up taking root at the same level. of the colon ensuring the achievement of a condition of eubiosis.

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