Response to the Letter to the Editor on the Article “Fecal Incontinence in Older Patients. A Narrative Review”

Dear Editor,

I thank you for the opportunity to reply to the Letter to the Editor by Bernal-Sprekelsen et al. in reference to the article on fecal incontinence in elderly patients.¹ Likewise, I would like to thank the authors for their interest and comments. There is absolute agreement in emphasizing the importance of a complete clinical history in the assessment of these patients, with special attention given to current pharmacological treatment. The therapeutic options for fecal incontinence should be implemented progressively, starting with conservative measures that include modifying stool consistency through all the factors that may influence it (defecation habits, diet and drugs, fundamentally).² Food intolerance should also be ruled out as a cause of chronic diarrhea. The presence of gastrointestinal symptoms in diabetic patients is related to the duration of the disease and glycemic control.³ As the authors point out, diarrhea and incontinence are attributed in greater proportion to the consumption of oral hypoglycemic agents than to the disease itself.

Metformin is an oral antidiabetic from the family of biguanides that is widely used for its safety profile, as it presents a low risk of producing hypoglycemia. There are several publications that correlate fecal incontinence with the change in stool consistency secondary to taking this drug. And, as Bernal-Sprekelsen et al. point out, the symptoms improve after its withdrawal.^4–6 Furthermore, certain drugs used in the treatment of cardiovascular diseases have diarrhea as a side effect. Antiplatelet agents like ticlopidine sometimes associate microscopic colitis,⁷ and olmesartan can lead to an enteropathy with a histopathological profile of villous atrophy, intraepithelial lymphocytosis and eosinophilic or collagenous colitis, called olmesartan-induced sprue-like enteropathy.^8–10