A diverticulum is an outpouching feature, usually filled with fluid, that arises in a given part of the human body. Intestinal diverticula are found in the mucosa of the colon, and they are finger-like prolongations of the mucosa creating a hollow sac that is nothing more than a prolongation of the membrane.
This is obviously not meant to be there, as it is usually formed due to an increase of pressure in the intestinal lumen, and may undergo a series of alterations. Diverticulitis is one of the most common. However, what is diverticulitis? Are probiotics useful in treating this condition?
What is Diverticulitis?
Diverticulitis is the inflammation of a diverticulum and comes under a spectrum of diseases called the diverticular disease. Diverticular disease is an outpouching of the colonic mucosa and the underlying connective tissue through a potential defect known as a diverticulum. Diverticular disease can take several forms:
- Diverticulosis: It is an asymptomatic diverticulum
- Painful diverticular disease: Characterized by occasional abdominal pain
- Bleeding diverticular disease: When the diverticulum formation involves damage to the blood vessels
- Diverticulitis: When the main problem is inflammation of the diverticulum, causing pain and other complications we will further address.
Diverticular disease is more common in the elderly population about more than 50% of cases in people above 70 years. Symptomatic diverticulosis and complicated diverticulosis are less common than asymptotic diverticulosis.
Diverticulitis occurs due to fecal impaction in the diverticulum, which can lead to either ischaemic necrosis of the diverticulum or an infectious process. Patients usually report nausea, fever, tachycardia, and abdominal pain. The location of pain in the abdomen is in accordance with the location of diverticulitis, commonly found in the sigmoid colon in people in the western countries and the ascending colon/transverse colon/hepatic flexure in the Asian population.
If diverticular disease/diverticulitis is not treated in time, it can lead to severe complications such as intestinal perforation, sepsis, and fistula formation (colovesicular fistula). Diverticulitis more often presents as an acute problem requiring immediate medical attention.
Probiotics and their health benefits
Probiotics are living microorganisms, strains of bacteria and yeasts used to replace the pathogenic bacteria and promote the normal flora of the gut to boost the immunity and normal gastrointestinal function of the body. Probiotics can be of various types, such as lactobacilli, the most common probiotic used to treat bowel diseases and diarrhea. Probiotics can take a few weeks to show their potential, but once the body gets used to it, it can be the best remedy for chronic diseases such as skin problems, mental issues, and gastric problems.
In more than 85% of newborns, the meconium is sterile, and only 15 to 20% contains a few organisms. In all cases, the gut is slowly invaded by healthy bacteria from the first day we were born and are beneficial in the following ways:
- Probiotics help us to synthesize several vitamins such as vitamin K, which is essential for blood clotting. It promotes the enzymatic gamma-carboxylation of the glutamic acid residues of the clotting factors so that they can be activated.
- Probiotics help us synthesize several B vitamins.
- Some probiotics produce natural antibiotic substances called colicins, with harmful effects on transient pathogenic flora, controlling the invasion of the gut by pathogenic organisms. With this antibiotic function, they prevent the colonization of the harmful pathogenic flora and maintain their own colonies.
- They interact with our body’s immune system, activating it to fight similar bacteria with similar antigens than the normal flora. A better trained immune system fights infection more effectively when it is required.
- Some probiotics produce endotoxin in a small amount, which may help our body’s defense mechanism to trigger the alternative complement pathways.
- Probiotics also maintain bowel consistency; for example, if the normal flora is damaged or decreased in number, the yeast starts to grow rapidly, leading to diarrhea. This is commonly seen in cases of excessive antibiotic use, which cause suppression of healthy flora of the gut and overgrowth of yeasts and other pathogenic organisms.
Probiotics and Diverticulitis
One of the causes of diverticulitis is the presence of pathogenic organisms in the fecal matter, which trigger inflammation, colonization, and complications of diverticular disease.
The feces should normally contain non-pathogenic or healthy intestinal flora, but pathogenic bacteria have a higher chance to enter the bloodstream, causing hematogenous spread and sepsis as a complication of diverticulitis, leading to severe consequences.
In these cases, probiotics can be very helpful, even in asymptomatic diverticular disease, as it prevents any growth of pathogenic bacteria and nourishes the healthy flora of the gut. These foods and supplements provide the gut with non-pathogenic microorganisms that reduce the risk of developing diverticulitis and its complications
One of the risk factors for the development of diverticular disease is the absence or low fiber diet. But some probiotic foods, such as fermented vegetables, pickles (kimchi) contain high dietary fiber, which also helps minimize the risk factors for developing this disease. Moreover, patients with diverticular disease often complain of painful digestion, which can be relieved with probiotic foods that contain digestive enzymes and make the whole digestive system more efficient to do its work.
Probiotics have a pH that is more friendly for the gut and improves gut mobility and digestion. Thus, by improving bowel movements and reducing the risk of complications, probiotic foods are a suitable ally for people who have a diverticular disease or anyone diagnosed with asymptomatic diverticula.
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The use of probiotics decreases, directly and indirectly, the risk factors for developing diverticulitis and its consequences. They are not expensive, will be useful to prevent other gastrointestinal diseases, and contribute to our nutrition in various ways.
White, J. A. (2006). Probiotics and their use in diverticulitis. Journal of clinical gastroenterology, 40, S160-S162.
Lahner, E., Bellisario, C., Hassan, C., Zullo, A., Esposito, G., & Annibale, B. (2016). Probiotics in the Treatment of Diverticular Disease. A Systematic. J Gastrointestin Liver Dis, 25(1), 79-86.
Narula, N., & Marshall, J. K. (2010). Role of probiotics in management of diverticular disease. Journal of gastroenterology and hepatology, 25(12), 1827-1830.
Tursi, A. (2011). Antibiotics and probiotics in the treatment of diverticular disease. Journal of clinical gastroenterology, 45, S46-S52.