The effect of dietary fibre modification and bowel rest on patient and health care outcomes in patients admitted to hospital with acute, uncomplicated diverticulitis: a systematic literature review and meta-analysis

Due to lack of evidence and conflicting clinical guidelines, the inpatient and discharge treatment approach for acute, uncomplicated diverticulitis varies widely in practice in Australia and internationally. Dietary management for acute, uncomplicated diverticulitis may include some combination of bowel rest, food deprivation, a standard diet, a low fibre diet, and/or progression to a higher fibre diet. These modifications are hypothesised to improve patient symptoms, reduce complications and prevent reoccurrence; however, are not yet supported by high-quality evidence, and may increase patient burden and health care costs. Therefore, in adults admitted to hospital with acute, uncomplicated diverticulitis, this systematic review and meta-analysis aimed to determine the impact of inpatient bowel rest as well as inpatient and post-discharge modified dietary fibre intake on patient and health care outcomes. Intervention and observational studies were searched for using PubMed, EMBASE, The Cochrane Library, Web of Science and CINAHL from database conception until October 2016, where 5524studies, excluding duplicates, were identified for screening. A meta-analysis will be performed using odds ratios and standardised mean differences (using a random-effects model). Primary outcomes will be hospital readmission rates and cumulative rehospitalisation length of stay. Secondary outcomes are gastrointestinal symptoms, quality of life, patient satisfaction, visits to the general practitioner and hospital length of stay. This review will help to identify strategic research opportunities and inform clinical practice guidelines so that patient outcomes and experiences may be improved internationally.