Diverticulosis is a deficiency disease caused by a shortage of dietary fibre(Reference Santhini and Savvas1); 20% of subjects will develop diverticulitis and need antibiotics(Reference Parks2). Dietary advice includes increasing intake of vegetable fibre, but giving probiotics during and after antibiotics for a diverticulitis attack may also be beneficial(Reference Giaccari, Tronci and Falconieri3,Reference Fric and Zavarol4). Estimates of the prevalence of diverticulosis based on subjects aged ≥40 years vary from 6–8% in African countries to 25–50% in European countries(Reference Blachut, Paradowski and Garcarek5,Reference Hughes6). In North America the incidence in subjects aged >50 years has been estimated at 40% and 10–25% developed diverticulitis(Reference Parks2). According to these studies there is no significant gender bias. However, in the present survey, data derived from UK primary-care electronic records show a lower prevalence of diverticulosis of 11% and the attack rate for diverticulitis per 5 years is two to three times higher in females than males (P<0.001). Although there are more women than men with known diverticulosis, female longevity is a confounding factor. The 7.4% prevalence of diverticulosis in subjects aged >55 years from the general practitioner (GP) records may be an underestimate compared with total population screening for diverticulosis(Reference Blachut, Paradowski and Garcarek5,Reference Hughes6).
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. Several responses to an open-ended comments section seemed to back up this trend: ‘Since starting to take a liquid probiotic daily (friend recommendation) frequency & discomfort of attacks has reduced’.
M, male; F, female.
Patients who stay on a long-term daily probiotic regimen appear to have fewer attacks of diverticulitis but the power of this retrospective survey was inadequate to test the hypothesis that probiotics are genuinely beneficial. A larger prospective trial is needed and it is suggested that subjects should be recruited who have had two or more episodes of diverticulitis. An open label pilot study of a daily dose of a probiotic for 2 years could be the next stage but ultimately a randomised control trial of probiotic v. a placebo will be essential.
