***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose Transcutaneous electrical stimulation ( TES ) speeds up colonic transit in children with slow-transit constipation ( STC ) . This study examined if concurrent upper gastrointestinal dysmotility ( UGD ) affected response to TES . Methods  Radio-nuclear transit studies ( NTS ) were performed before and after TES treatment of STC as part of a larger r and omised controlled trial . UGD was defined as delayed gastric emptying and /or slow small bowel transit . Improvement was defined as increase of ≥1 Geometric Centre ( median radiotracer position at each time [ small bowel = 1 , toilet = 6 ] ) . Results Forty-six subjects completed the trial , 34 had NTS after stimulation ( 21 M , 8–17 years , mean 11.3 years ; symptoms > 9 years ) . Active stimulation increased transit in > 50 % versus only 25 % with sham ( p = 0.04 ) . Seventeen children also had UGD  . In children with STC and either normal upper GI motility ( NUGM ) and UGD , NTS improved slightly after 1 month ( 57 vs. 60 % ; p = 0.9 ) and more after 2 months ( 88 vs. 40 % ; p = 0.07 ) . However , mean transit rate significantly increased with NUGM , but not UGD ( 5.0 ± 0.2 : 3.6 ± 0.6 , p < 0.01 ) . Conclusion Transcutaneous electrical stimulation was beneficial for STC , with response weakly associated with UGD . As measured by NTS , STC children with NUGM responded slightly more , but with significantly greater increased transit compared to those with UGD . Higher numbers are needed to determine if the difference is important OBJECTIVE To evaluate our initial experience using sacral neuromodulation via implanted pulse generator as a treatment for children with dysfunctional elimination syndrome and symptoms refractory to maximum medical therapy . MATERIAL S AND METHODS There were 105 consecutive patients who underwent a 2-stage procedure with a trial period ( n = 89 ) or a single procedure ( n = 16 ) for device implantation .  They were followed up prospect ively for a median of 2.72 years ( average , 3.18 years ; range , 0.01 - 9.63 years ) for symptom improvement and resolution . RESULTS Nearly all children ( 99 of 105 [ 94 % ] ) experienced improvement of at least 1 symptom ; 12 of 105 patients ( 11 % ) had at least 1 symptom worsen . Urinary incontinence , constipation , frequency and /or urgency , and nocturnal enuresis improved in 89 of 101 ( 88 % ) , 73 of 92 ( 79 % ) , 54 of 81 ( 67 % ) , and 59 of 89 ( 66 % ) children , respectively , and resolved in 41 of 101 ( 41 % ) , 37 of 92 ( 40 % ) , 23 of 81 ( 28 % ) , and 25 of 89 ( 28 % ) children , respectively . Outcomes among patients who did and did not undergo the trial were not significantly different ( P = .19 - 1.00 ) , and only 2 of 88 patients did not undergo permanent implantation . Reoperations ( n = 85 ) occurred in 59 of 105 children ( 56 % ) , mainly for device malfunction ( n = 42 ) , whereas explantation was performed in 36 of 104 children ( 35 % ) at an average of 2.68 years since implantation ( median , 2.36 years ; range , 0.03 - 9.04 years ) , mainly for complete symptom resolution ( n = 12 ) . Explantation for any reason was less common after single-stage procedures ( 1 of 16 [ 6 % ] vs 35 of 88 [ 40 % ] patients ; P = .01 ) . CONCLUSION Sacral neuromodulation should be considered for children with dysfunctional elimination syndrome whose symptoms are refractory to maximum medical therapy underst and ing that the risk of reoperation is > 50 % . Elimination of the trial period reduces the number of general anesthetics without sacrificing outcomes PURPOSE Idiopathic slow transit constipation ( STC ) describes a clinical syndrome characterised by intractable constipation . It is diagnosed by demonstrating delayed colonic transit on nuclear transit studies ( NTS ) . A possible new treatment is interferential therapy ( IFT ) , which is a form of electrical stimulation that involves the transcutaneous application of electrical current . This study aim ed to ascertain the effect of IFT on colonic transit time . METHODS Children with STC diagnosed by NTS were r and omised to receive either 12 real or placebo IFT sessions for a 4-week period . After a 2-month break , they all received 12 real IFT sessions-again for a 4-week period . A NTS was repeated 6 to 8 weeks after cessation of each treatment period where able . Geometric centres ( GCs ) of activity were calculated for all studies at 6 , 24 , 30 , and 48 hours . Pretreatment and posttreatment GCs were compared by statistical parametric analysis ( paired t test ) . RESULTS Thirty-one pretreatment , 22 postreal IFT , and 8 postplacebo IFT studies were identified in 26 children ( mean age , 12.7 years ; 16 male ) .  Colonic transit was significantly faster in children given real treatment when compared to their pretreatment NTS at 24 ( mean CG , 2.39 vs 3.04 ; P < or = .0001 ) , 30 ( mean GC , 2.79 vs 3.47 ; P = .0039 ) , and 48 ( mean GC , 3.34 vs 4.32 ; P = .0001 ) hours . By contrast , those children who received placebo IFT had no significant change in colonic transit . CONCLUSIONS Transcutaneous electrical stimulation with interferential therapy can significantly speed up colonic transit in children with slow transit constipation AIMS Transcutaneous electrical stimulation ( TES ) was used to treat children with slow-transit constipation ( STC ) for 1 to 2 months in a r and omized controlled trial during 2006 to 2008 . We aim ed to determine long-term outcomes , hypothesizing that TES produced sustained improvement . METHODS Physiotherapists administered 1 to 2 months of TES to 39 children ( 20 minutes , 3 times a week ) . Fifteen continued to self-administer TES ( 30 minutes daily for more than 2 months ) . Mean long-term follow-up of 30 of 39 patients was conducted using question naire review 3.5 years ( range 1.9 - 4.7 years ) later . Outcomes were evaluated by confidence intervals or paired t test . RESULTS Seventy-three percent of patients perceived improvement , lasting more than 2 years in 33 % and less than 6 months in 25 % to 33 % . Defecation frequency improved in 30 % . Stools got wetter in 62 % after stimulation and then drier again . Soiling improved in 75 % and abdominal pain in 59 % . Laxative use stopped in 52 % , and 43 % with appendicostomies stopped washouts . Soiling/Holschneider continence score improved in 81 % ( P = .0002 ) . Timed sits switched to urge-initiated defecations in 80 % patients . Eighty percent of relapsed patients elected to have home stimulation . CONCLUSION TES holds promise for STC children . Improvement occurred in two thirds of children , lasting more than 2 years in one third , whereas symptoms recurred after 6 months in one third of children Aim Transcutaneous electrical nerve stimulation ( TENS ) is a possible alternative to sacral nerve stimulation because the neurophysiologic targets might be similar but the former method is non-invasive and cheaper . The aim of the study was to assess both symptom and quality of life ( QoL ) improvements in patients suffering from severe FI . Methods Thirty two patients ( M/F , 30/2 ; age , 61 ± 13 years ) were enrolled in a pilot trial because they suffered from a severe and stable FI ( Clevel and Score14.5 ± 2.8 [ 11–20 ] ) for a long duration ( 95 ± 91 months ) . TENS was delivered 20 min bis in die at home ( Schwa Medico , P3 ) . Assessment was realized at 1 , 3 , and 6 months with both semi-directive and self-administered question naires . Main endpoint was the quantified success rate after 1 month of follow-up . Results Mean subjective improvement was 26 ± 30 % : 20 ( 63 % ) patients reported some degree of improvement and 10 ( 32 % ) at least a 25 % improvement in fecal incontinence . The Clevel and score significantly decreased at 1 ( 11 ± 4 ; p < 0.001 ) , 3 ( 11 ± 5 ; p < 0.001 ) , and 6 ( 10 ± 5 ; p < 0.001 ) months . All subscales of QoL were significantly improved after a 3-month period of stimulation . However , constipation score and number of pads did not change . There was no adverse event . Conclusion TENS provides slight improvement in FI . This justifies both neurophysiology assessment and r and omized controlled studies before further diffusion of the technique PURPOSE Transcutaneous electrical stimulation ( TES ) ( 3 sessions/wk ) over the abdomen stimulated bowel functions in a r and omized controlled trial . This pilot study assessed whether daily TES at home with a safe , portable machine would be possible and more efficacious than trial results . METHODS Eleven patients ( 6 male/5 female ; mean age , 14 years ; range , 12 - 18 years ) with slow-transit constipation who relapsed or responded poorly in the trial were recruited ( 11 + /- 5 months later ) . An EPM-IF-4160 ( Fuji Dynamics , Hong Kong ) portable machine ( sine waveform , 4 kHz carrier frequency , 80 - 160 Hz beat frequency , intensity <33 mA ) delivering interferential current ( 2 electrodes over epigastrium + 2 over kidneys ) was applied 1 hour daily at home . Continence diaries were kept for 1 month before and 2 months during treatment . RESULTS All children completed more than 1 month of treatment after baseline recording . Defecation increased in 9 of 11 children , and soiling decreased in 4 of 11 children . There was a significant increase in total episodes of defecation per week ( mean + /- SD , 2.5 + /- 2.1 vs 6.7 + /- 4.4 ; P = .008 ) and a nonsignificant decrease in soiling ( 3.8 + /- 1.6 vs 1.1 + /- 0.5 episodes/wk , P = .1 ) . Daily stimulation does not affect abdominal pain . No adverse events occurred . CONCLUSIONS Daily TES at home is safe and significantly improved bowel function in children who did not respond to 3 times per week of TES . Home TES may be a novel treatment of intractable slow transit constipation , avoiding hospital visits OBJECTIVES : Although it has been used as a laxative for many years , high- quality trials assessing the efficacy of the laxative sodium picosulfate ( SPS ) are lacking . The purpose of this study was to assess the efficacy and safety of 4-week treatment with SPS in patients with functional constipation as defined by the Rome III diagnostic criteria . METHODS : This study was a r and omized , double-blind , placebo-controlled , parallel-group study in 45 general practice s in Germany . A total of 468 patients with chronic constipation presenting to their general practitioner and fulfilling the Rome III diagnostic criteria were screened . After a 2-week baseline period , 367 patients were r and omized to either SPS drops or matching placebo in a 2:1 ratio for 4 weeks . Dose titration was permitted throughout treatment . Patients without a bowel movement for more than 72 h were allowed to use a “ rescue ” bisacodyl suppository . The primary end point was the mean number of complete spontaneous bowel movements ( CSBMs ) per week . A spontaneous bowel movement ( SBM ) was defined as a stool not induced by rescue medication , whereas a CSBM was defined as an SBM associated with a sensation of complete evacuation . RESULTS : The mean number ( ±s.e . ) of CSBMs per week increased from 0.9±0.1 to 3.4±0.2 in the SPS group and from 1.1±0.1 to 1.7±0.1 in the placebo group ( P<0.0001 ) . The percentage of patients reaching an increase of ≥1 in the mean number of CSBMs per week compared to baseline was 65.5 % vs. 32.3 % , respectively ( P<0.0001 ) . The percentage of patients reaching a mean number of at least three CSBMs per week was 51.1 % in the SPS group and 18.0 % in the placebo group ( P<0.0001 ) . After 24 h , approximately 69 % of patients in the SPS group and 53 % in the placebo group had their first SBM . The SPS dose was titrated down during the study by nearly  
    Output:
    
The radiological assessment of colonic transit outcomes means that these results might not translate to important improvement in clinical symptoms or increased bowel movements .