Bond University Camilla Dahl Bond University Megan Crichton Bond University Julie Jenkins Bond University
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1 Bond University Faculty of Health Sciences & Medicine Publications Faculty of Health Sciences & Medicine Dietary fibre modification in the recovery and prevention of reoccurrence of acute, uncomplicated diverticulitis: A systematic review and meta-analysis Camilla Dahl Bond University Megan Crichton Bond University Julie Jenkins Bond University Romina Nucera Bond University Sophie Mahoney Bond University See next page for additional authors Follow this and additional works at: Part of the Nutrition Commons, and the Rehabilitation and Therapy Commons Recommended Citation Dahl, C., Crichton, M., Jenkins, J., Nucera, R., Mahoney, S., & Marshall, S. (2017). Dietary fibre modification in the recovery and prevention of reoccurrence of acute, uncomplicated diverticulitis: A systematic review and meta-analysis. Retrieved from This Conference Presentation is brought to you by the Faculty of Health Sciences & Medicine at epublications@bond. It has been accepted for inclusion in Faculty of Health Sciences & Medicine Publications by an authorized administrator of epublications@bond. For more information, please contact Bond University's Repository Coordinator.
2 Authors Camilla Dahl, Megan Crichton, Julie Jenkins, Romina Nucera, Sophie Mahoney, and Skye Marshall This conference presentation is available at
3 CRICOS CODE 00017B Dietary fibre modification in the recovery and prevention of reoccurrence of acute, uncomplicated diverticulitis: a systematic review and meta-analysis By Camilla Dahl, Megan Crichton, Julie Jenkins, Romina Nucera, Sophie Mahoney, Skye Marshall
4 Sandler et. al. Gastroenterology, 2002; AIHW 2016 ACUTE UNCOMPLICATED DIVERTICULITIS
5 Guideline/Statement Updated Diet Recommendation American Gastroenterological Association Institute American Society of Colon & Rectal Surgeons 2015 No comment 2014 Bowel rest Italian Society of Colon & Rectal Surgery World Society of Emergency Surgery 2015 No comment 2015 Dietary restriction is unproven Danish Surgical Society 2011 Dietary restriction is unproven World Gastroenterology Organisation 2007 Bowel rest should be used in the first 48 hours
6 ACUTE, UNCOMPLICATED DIVERTICULITIS Restricted Diet Nil by mouth Clear fluids Liberalised Diet Full diet Free fluids Lower Fibre <10g/day Higher Fibre >25g/day
7 RESEARCH QUESTION The efficacy of dietary fibre modifications, either alone or alongside probiotics and antibiotics, versus any comparator on recovery, gastrointestinal symptoms, health care use and reoccurrence
8 SYSTEMATIC REVIEW METHODS Duplicated independently by two authors Identification of studies Applied eligibility criteria Data extraction Critical appraisal Data analysis / meta-analysis PROSPERO registration number: CRD
9
10 Study Design Treatment failure result for Study Study Design LOS Reoccurrence result for liberal vs liberal vs restricted result for Length of stay restricted liberal Reoccurrence vs restricted Ridgway RCT, n=79 Ridgway 2009 RCT, n=79 Ø (lib. Vs bowel rest) Ridgway 2009 RCT, n=79 (lib. (lib. Vs Vs bowel bowel rest) rest) 2009 Park Park Study Prospective Design GI symptom Vs bowel result for Ø (lib. Vs bowel rest) rest) Park 2011 observational Prospective liberal vs (lib. restricted Vs bowel rest) Ridgway cohort, observational RCT, n=79 n=103 Results: Ø Van de Wall Retrospective cohort, Lib n=103 (lib. Vs bowel rest) 2009 vs Res Van 2013 de Wall Retrospective Ø (lib. observational (lib. Vs Vs bowel bowel rest) rest) 2013 study, observational n=92 study, n=94 Treatment failure, n=116, n=116 Ø (lib. Vs Vs clear liquid) Change = P<0.05 Gastrointestinal symptoms, n=102, n=102 Ø (lib. Vs liquid diet)
11 Liberalised diet (inpatient or outpatient ) vs restricted diet (inpatient) (GRADE) Outcome & hypothesis Length of stay lower in liberalised diet Risk of bias (Cochrane) Inconsistency (heterogeneity) Indirectness (confidence in effect) Imprecision Publication bias Serious Not serious Serious Not serious N/A Quality of the body of evidence (GRADE) No difference in reoccurrence Serious Not serious Serious Serious N/A Both diets safe (low risk of treatment Serious Not serious Not serious Very serious N/A failures) No difference in GI symptoms Serious N/A Serious Serious N/A No difference in outpatient visits Very serious N/A Serious N/A N/A
12 Limitations Limited confidence Confounding variables Missed studies Wider outcome reporting 1 st to synthesise evidence Provides guidance Limited concerns, failures or safety problems Benefits
13 CONCLUSION 1. There is insufficient evidence to make recommendations; 2. Use clinical expertise and incorporate patients values and preferences in a patient centered care approach; 3. More research is needed PUBLICATION Submitted shortly High dietary fibre advice upon discharge
14 Funding declaration: This research received no specific funding Conflict of interest: None Thank you Any questions?
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