The role of fibre in the aetiology and treatment of diverticular disease has been recognized in the gastroenterology literature for at least 40 years. In 1971 Burkitt and Painter described diverticulosis as a dietary deficiency of Western civilization, like scurvy, that could be avoided with an adequate diet. A survey of 224 gastroenterologists at the World Congress in the mid-1970s would suggest that this opinion was widely held, as 75% of those surveyed recognized the role of fibre in the prevention and treatment of diverticular disease. However this confidence is not supported by the published literature, with only five randomized controlled trials primarily assessing the role of fibre in diverticular disease, which have included less than 250 patients in total. This chapter will discuss the classification of fibre, the proposed mechanism for action of fibre supplementation, and then describe the evidence of its role in the prevention of diverticulosis, the treatment of symptomatic diverticular disease, and prevention of complications relating to diverticular disease.
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