Probiotics and Diverticulitis: What Does the Research Really Say?

Diverticulitis is a common and often painful condition linked to inflammation and imbalance in the gut microbiome. While standard treatments focus on antibiotics, diet and symptom control, research suggests that restoring healthy gut bacteria may also play a role in prevention and recovery. Probiotics, which are live beneficial microorganisms, are being studied for their ability to reduce inflammation, strengthen the gut barrier and alleviate symptoms such as bloating and abdominal pain. This article offers a closer look at what is currently known: the role of the microbiome in diverticular disease, the research findings on probiotics for diverticulitis and the strains that could be the best probiotics for diverticulitis.

Diverticulitis in context

Small pouches, called diverticula, sometimes form in the wall of the colon. The development of multiple such pouches is referred to as diverticulosis, although most people with this condition typically do not have any symptoms. Diverticulitis occurs when one or more of these diverticula become inflamed. It can cause sudden and often severe abdominal pain, fever and digestive disturbances. Diverticulitis can also lead to complications, such as abscesses or perforations. Diverticular disease is a broader term that refers to all symptomatic cases related to diverticula, including both chronic discomfort and acute inflammation.¹

Diverticulosis is highly prevalent in Western populations, especially among older adults.² In North America, Europe and Australia, over 50% of people aged 60 and above have diverticulosis detected on imaging or colonoscopy, while the prevalence approaches 70% to 80% in those older than 80 years. Diverticular disease and diverticulitis are less common than diverticulosis, but their incidence also increases with age. Approximately 10% to 25% of individuals with diverticulosis will develop symptomatic diverticular disease or diverticulitis during their lifetime.³

Diverticular disease and diverticulitis are primarily driven by:

• Dietary patterns
• Gut microbiome changes
• Low fibre intake
• Chronic inflammation

A combination of these risk factors is most pronounced in Western populations and among older individuals.⁴ Genetic predisposition may play a secondary role, while regular use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can also increase risk.^5,6

Standard management of diverticular disease and diverticulitis involves dietary modification, medical therapy and, in some cases, surgery.⁷ There is a growing interest in complementary approaches such as probiotics due to their potential to target underlying microbiome and inflammation issues.

The gut microbiome’s role in diverticular disease

A healthy gut microbiome is characterised by its rich diversity, stability and balanced abundance of beneficial bacteria, including Bifidobacterium, Lactobacillus, Bacteroides and Faecalibacterium. This balanced microbial community is essential for optimal digestion, metabolism, immune defence and protection against harmful microbes.^8,9

Gut microbes turn dietary fibres into short-chain fatty acids (SCFAs) such as butyrate. These SCFAs are crucial for nourishing colonocytes (cells that line the gut) and maintaining the physical barrier of the gut mucosa, which prevents the invasion of pathogens and toxins. Beneficial bacteria regulate the connections between intestinal epithelial cells, preventing “leaky gut” and supporting resilience against injury or inflammation.⁸

Evidence suggests that an imbalance in the gut microbiome, known as dysbiosis, can increase susceptibility to diverticulitis flare-ups. This may be caused by changes in the microbiome that promote local inflammation, thereby weakening mucosal integrity and allowing pathogenic bacteria to thrive.¹⁰

Studies have shown that individuals with recurrent or severe diverticulitis often display decreased microbial diversity and lower levels of protective bacteria.^11,12,13 During an acute diverticulitis flare, microbiota diversity decreases, and specific changes emerge, including a greater abundance of pro-inflammatory and potentially pathogenic bacteria, particularly Enterobacteriaceae, Streptococcus and Bacteroides.^14,15

These changes are accompanied by reductions in beneficial SCFA-producing bacteria (Bifidobacterium, Lactobacillus, Roseburia), which weaken mucosal integrity and fuel inflammation.^16,17 Increases in the inflammatory biomarker calprotectin, as well as severity of abdominal pain and bloating, are associated with higher levels of Ruminococcus and loss of Roseburia.^18,19

Can probiotics help with diverticulitis?

Diverticulitis is associated with loss of beneficial bacteria and overgrowth of pro-inflammatory species. Therefore, probiotic strains (such as Lactobacillus acidophilus, Bifidobacterium lactis and Lactobacillus reuteri) can increase the abundance of anti-inflammatory bacteria and suppress pathogenic populations, potentially reducing the risk of future flare-ups.²⁰

Probiotics that produce SCFAs can lower local inflammation while helping to repair and maintain the integrity of the gut lining, thereby lowering the risk of complications. Evidence also suggests probiotics may decrease abdominal pain, bloating and other gastrointestinal discomfort in patients with diverticular disease or after episodes of diverticulitis.^20,21

While probiotics are not a cure for diverticulitis or diverticular disease, current research suggests they may have a role in supporting gut health, microbiome balance and symptom management.

Evidence from human studies

Human research investigating probiotics for diverticulitis is still evolving, but a growing number of clinical trials suggest that they offer symptomatic and anti-inflammatory benefits. They may be beneficial in uncomplicated disease and as adjunct therapy to enhance recovery from acute diverticulitis.

Across numerous small clinical studies, probiotics have been tested either alone, in combination with anti-inflammatory or antibiotic agents, or as part of synbiotic formulations. The majority of trials reported improvements in abdominal pain, bloating and bowel habit regularity, alongside reductions in inflammatory biomarkers such as C-reactive protein (CRP) and faecal calprotectin.^21,22 While the methodological quality of studies has varied, and some trials did not find statistical significance, the overall pattern indicates that probiotics may help restore microbial balance and modulate local inflammation.

Several species commonly used in consumer probiotic foods and supplements, such as Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus reuteri and Bifidobacterium lactis, have been suggested as the best probiotics for diverticulitis.

• Lactobacillus reuteri reduced abdominal pain and inflammatory markers when added to standard therapy for acute uncomplicated diverticulitis.²³
• Multi-strain blends containing B. lactis, Lactobacillus acidophilus and Lactobacillus salivarius demonstrated reduced CRP and abdominal discomfort compared with standard care alone.²⁴
• Lactobacillus casei and Lactobacillus paracasei strains improved symptoms and maintained remission in uncomplicated diverticular disease, especially when combined with a high-fibre diet.²⁵

Combining probiotics with other therapies or prebiotic substrates may enhance their effects. Co-administration with mesalazine, beclomethasone or rifaximin has resulted in additive symptom improvement in several studies, suggesting that probiotics may complement, rather than replace, conventional medical treatment.^26,27,28,29

High-quality randomised trials into the potential of probiotics as a treatment for diverticulitis are still ongoing. Currently, their role is best viewed as complementary, offering a low-risk mechanism to improve gut resilience and comfort in individuals susceptible to diverticulitis.

Clinical application: what to tell patients

Assessing whether a patient may benefit from probiotic supplementation for diverticulitis or diverticular disease involves a careful evaluation of symptoms, clinical history, risk factors and patient-specific considerations. Probiotics are generally safe for most individuals, but should be avoided in those with severely compromised immune systems or patients with critical illnesses.

Probiotics for diverticulitis are used as complementary, not primary, therapy. They do not replace antibiotics, anti-inflammatory drugs or surgical interventions that are needed in acute or complicated cases. The American Gastroenterological Association and similar organisations do not formally recommend probiotics for diverticulitis due to a lack of high-quality evidence.^22,30,31

Probiotics may help maintain regularity, reduce abdominal pain and aid recovery from acute illness by optimising microbial balance and mucosal integrity, especially when used alongside dietary and lifestyle interventions.

Patients interested in non-pharmacological options who are motivated and able to adhere to daily supplementation may experience improvements in symptoms or quality of life, especially when evidence-based strains are selected.

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