Investigation of Medical Management to Prevent Episodes of Diverticulitis (IMPEDE) trial

Diverticulitis is one of the most common gastrointestinal indications for inpatient hospital admission, outpatient clinic and emergency room visits, and colon surgery. At least 20% of individuals with an initial episode of diverticulitis will have one or more painful and unpredictable recurrences. Unfortunately, there is no proven pharmacologic means to decrease the risk of diverticulitis.

Large, prospective, observational studies have identified diet and lifestyle risk factors for incident diverticulitis. However, these modifiable risk factors have not been evaluated for secondary prevention.

Studies of diet and plasma inflammatory markers suggest that chronic, systemic inflammation is a potential mechanism that underlies the dietary effects on diverticulitis development.

The Mediterranean diet pattern is comparable to diets associated with primary prevention of diverticulitis, is more strongly associated with reduced inflammation, and is familiar to providers and many patients.

Thus, the researchers propose to conduct a randomized trial (n=75) of a USDA Healthy Med- style Food Pattern versus standardized guidance on fiber intake for patients with diverticulitis to evaluate the feasibility of this dietary intervention including willingness to randomize and adherence to a Med-style dietary pattern.

This project has received NIH funding, with MPIs Drs. Lisa Strate and David Flum.

Lisa Strate, M.D., M.P.H., is a professor of medicine (Gastroenterology) and Gastroenterology Section Head at Harborview Medical Center. She is internationally recognized for her investigations into risk factors for diverticular disease progression including diet, lifestyle and genetics. Her work has informed guidelines, changed dietary recommendations, and formed the basis of current medical measures for prevention of diverticulitis. She has also established seminal data regarding the role of chronic inflammation and the gut microbiome in diverticulitis.

David R. Flum, MD, MPH, is a professor and associate chair for research in the UW Department of Surgery.  He leads UW Medicine's Surgical Outcomes Research Center, and directs the Comparative Effectiveness Research Translation Network, a national network that tests the effectiveness of healthcare interventions.