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Inicio Cirugía Española (English Edition) Fecal Incontinence in Older Patients: A Narrative Review
Información de la revista
Vol. 96. Núm. 6.
Páginas 391-392 (junio - julio 2018)
Vol. 96. Núm. 6.
Páginas 391-392 (junio - julio 2018)
Letter to the Editor
Acceso a texto completo
Fecal Incontinence in Older Patients: A Narrative Review
Incontinencia fecal en el paciente anciano. Revisión de conjunto
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Juan Carlos Bernal-Sprekelsen
Autor para correspondencia
jcbernal@comv.es

Corresponding author.
, Guillermo Felipe Valderas Cortés, Laura Gómez Romero
Unidad de Coloproctología, Hospital General Universitario, Valencia, Spain
Contenido relacionado
Ana María García Cabrera
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We have read with interest the narrative review on fecal incontinence (FI) in elderly patients by the authors García Cabrera et al.,1 published in the March issue of Cirugía Española.

The authors comment that the treatment of FI in these patients should be a combination of habit modification, hygiene-dietary measures, medication and, to a lesser extent, surgery. We cannot agree more with this statement, but it should be emphasized that, among the predisposing factors mentioned, polypharmacy in the geriatric population is associated with a high morbidity secondary to adverse reactions and interactions, including fecal incontinence.

In the USA, 21.6% of the population over 65 years of age have diabetes mellitus2 with associated gastrointestinal disorders, including FI.3 The latest studies frequently give more importance to the side effects of oral antidiabetics (OAD) than to the disease itself. Metformin has been associated with intestinal transit alterations (25%) and diarrhea.4,5

Coloproctology units are referred diabetic patients with fecal incontinence secondary to pharmacological treatment in whom the simple withdrawal of the drug can rule out a significant cause of FI or its aggravation. Metformin causes intestinal hypermotility, malabsorption and sphincter hypocontractility.6 According to Dandona et al. in an older review,7 there is a strong association between episodes of diarrhea incontinence and reduced sphincter tone, and symptoms remit after the drug is withdrawn. Another drug implicated in FI is olmesartan, which is used in hypertension, with less impact than metformin, but with associated severe diarrhea and weight loss, and has been described as a “sprue-like” enteropathy.8,9

“De-prescribing” should be considered when there is polypharmacy and adverse drug reactions.10 In acute adult care, the number one cause of FI has been associated with medications (49%), followed by neurological disorders (40%).11

Therefore, we should bear in mind that certain medications such as metformin and olmesartan may cause or aggravate previous FI. At the same time, it is necessary to emphasize and remember the importance of the patient's clinical history and explore any possible adverse pharmacological effects by systematically reviewing current medical treatment before performing complementary tests such as manometry, endorectal ultrasound or other functional tests.12

References
[1]
A.M. García Cabrera, R.M. Jiménez Rodríguez, M.L. Reyes Díaz, J.M. Vázquez Monchul, M. Ramos Fernández, J.M. Díaz Pavón, et al.
Incontinencia fecal en el paciente anciano. Revisión de conjunto.
[2]
E. Selvin, J. Coresh, F.L. Brancati.
The burden and treatment of diabetes in elderly individuals in the U.S..
Diabetes Care, 29 (2006), pp. 2415-2419
[3]
P. Bytzer, N.J. Talley, M. Leemon, L.J. Young, M.P. Jones, M. Horowitz.
Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults.
Arch Intern Med, 161 (2001), pp. 1989-1996
[4]
L.J. McCreight, C.J. Bailey, E.R. Pearson.
Metformin and the gastrointestinal tract.
Diabetologia, 59 (2016), pp. 426-435
[5]
D. Maleki, G.R. Locke 3rd, M. Camilleri, A.R. Zinsmeister, B.P. Yawn, C. Leibson, et al.
Gastrointestinal tract symptoms among persons with diabetes mellitus in the community.
Arch Intern Med, 160 (2000), pp. 2808-2816
[6]
W.F. Caspary.
Biguanides and intestinal absorptive function.
Acta Hepato-Gastroenterol, 24 (1977), pp. 473-480
[7]
P. Dandona, V. Fonseca, A. Mier, A.G. Beckett.
Diarrhea and metformin in a diabetic clinic.
Diabetes Care, 6 (1983), pp. 472-474
[8]
G. Ianiro, S. Bibbò, M. Montalto, R. Ricci, A. Gasbarrini, G. Cammarota.
Systematic review: sprue-like enteropathy associated with olmesartan.
Aliment Pharmacol Ther, 40 (2014), pp. 16-23
[9]
E.S. González, F.C. Díaz Jaime, A. del Val Antoñana.
Perfil clínico-analítico, serológico e histológico de la enteropatía sprue-like asociada con la toma de olmesartán.
Rev Esp Enferm Dig, 108 (2016), pp. 685-686
[10]
M.C. Woodward.
Deprescribing: achieving better health outcomes for older people through reducing medications.
J Pharm Pract Res, 33 (2003), pp. 323-328
[11]
A.L. Stokes, C. Cromwell, K. Taylor-Thompson, A.L. Chong.
Prevalence of fecal incontinence in the acute care setting.
J Wound Ostomy Continence Nurs, 43 (2016), pp. 517-522
[12]
C. Gerstel, M. Zarate Lagunes, U.M. Vischer.
Fecal incontinence resolved using metformin withdrawal.
J Am Geriatr Soc, 59 (2011), pp. 756-757

Please cite this article as: Bernal-Sprekelsen JC, Valderas Cortés GF, Gómez Romero L. Incontinencia fecal en el paciente anciano. Revisión de conjunto. Cir Esp. 2018;96:391–392.

Copyright © 2018. AEC
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