What is it about?
Various assumptions about the incidence and management of diverticular disease in primary care have been made without any data having been gathered. In the United Kingdom (UK) primary care data on diverticular disease is not a priority whereas data on immunizations, blood pressure, cervical cytology and smoking is high priority, earns practice revenue and is, therefore highly reliable. We wanted to know the incidence of proven diverticular disease (usually on the basis of colonoscopy), the incidence of diverticulitis and dietary advice including advice on dietary fiber and the value of taking a daily probiotic. We identified a diagnosis of diverticular disease from the code for this diagnosis, confirmation by investigation (mainly colonoscopy). We found the code for acute diverticulitis was unreliable and identified this diagnosis mainly by tracking prescriptions of appropriate antibiotics. Results of a questionnaire sent out to patients who had been treated for diverticulitis in the previous 5 years indicated that ≥31% of patients with diverticulitis retained GP advice on dietary fibre and 15.6% recalled being advised to take a probiotic. At the time of completion of the questionnaire 32.5% of subjects were taking a probiotic regularly and further data analysis showed a trend for these subjects to have fewer bowel symptoms and slightly fewer episodes of diverticulitis, which did not reach significance.
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Why is it important?
The role of dietary fiber has long been recognized, especially in relation to prevention of diverticular disease but a role for a daily dose of a probiotic has only recently been suggested. There is some evidence that advice on the value of a daily probiotic is passed on by patients as much as by doctors and our data seemed to back up this observation. If taking a daily dose of a probiotic can reduce the incidence of acute diverticulitis, this strategy could significantly reduce the need for antibiotics which has to be a good thing.
Perspectives
We subsequently carried out a small trial of a daily dose of the probiotic Lactobacillus casei Shirota for 12 months. For this trial, we recruited just 21 probiotic naive subjects with a past history of confirmed diverticular disease and at least one episode of diverticulitis in the previous five years. There was no placbo control group and the small size of the trial mean that we could only claim this as a feasibility study to test the feasibility of a larger study in the primary care setting. This small study appeared to show a halving of the number of episodes of acute diverticulitis: https://escientificpublishers.com/assets/data1/images/ANPH-02-0016.pdf
Dr John Anthony Alvan Nichols
Royal Society of Medicine
Read the Original
This page is a summary of: Survey of incidence of diverticular disease, dietary advice and probiotic advice in three Surrey practices, Proceedings of The Nutrition Society, January 2010, Cambridge University Press,
DOI: 10.1017/s0029665109992977.
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