Priscilla Marsicovetere is Assistant Professor of Medical Education and Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, and Program Director for the Franklin Pierce University, PA Program, Lebanon, New Hampshire. She practices with Emergency Services of New England, Springfield Hospital, Springfield, Vermont.
The author has no financial relationships to disclose.
Historically, patients with diverticulitis were advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk for complications. But studies have found no support for this caution. In a 2008 large, prospective study of men without known diverticular disease, the researchers found no association between nut, corn, or popcorn ingestion and diverticulitis; in fact, increased nut intake was specifically associated with a lower risk for diverticulitis.15
Smoking
Smoking has been linked to diverticulitis and has been associated with a threefold risk for complications, including severe diverticulitis.16,17 An increased risk for recurrent episodes has also been found in smokers following surgical intervention.17
Medications
NSAIDs, corticosteroids, and opioids have been associated with an increased risk for perforated diverticulitis.18,19 A significant association has been found between NSAID use and severity of diverticulitis, including perforation; one study reported a relative risk of 1.25 (95% confidence interval, 10.5 to 1.47) for diverticulitis with regular use of aspirin (≥ 2x/wk).20,21
More frequent steroid use has been found in patients with complicated diverticulitis, compared to patients with uncomplicated disease (7.3% vs 3.3%; P = .015).22 A systematic review of five studies comparing patients with and without steroid use showed significantly higher odds of diverticular perforation in patients taking a steroid.23 Pooled data showed significantly increased odds of perforation and abscess formation with use of an NSAID (odds ratio [OR], 2.49), steroid (OR, 9.08), or opioid (OR, 2.52).22
