Response to 'Letter to editor'.

Sir,

We thank our readers for their interest in our work and the valuable comments. In our study, we executed the beneficial effect of gum chewing in addition to standard bowel preparation regimen for colonoscopic examination.[1]

Sorbitol-induced osmotic diarrhea has been shown to be associated with excessive intake of sorbitol as high as 20–50 g/day.[2] It means that to encounter this uncommon side effect, patients must consume upward of 20 sticks of gum a day. Our patients consumed only three gums daily. On the other hand, in our study we advised our patients to chew sugarless mastic-flavored gum, which did not contain any sweetener such as sorbitol, xylitol, and aspartame.

Chewing gum increases gastric secretions during the cephalic phase of nutrition and intestinal motility through the release of neuropeptides. Recent meta-analysis and systematic reviews about colorectal and gynecological surgery supports that gum chewing promotes bowel functions.[34]

Finally, we agree that in daily practice sorbitol-containing gums also may be used in low doses in adjunct to colonoscopy preparation due to its probable additive osmotic effect.