***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 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 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 BACKGROUND Slow transit constipation ( STC ) causes intractable symptoms not responsive to medical treatment . Children have irregular bowel motions , colicky abdominal pain , and frequent soiling .  Transcutaneous electrical stimulation using interferential current ( interferential therapy [ IFT ] ) is a novel treatment of STC . This study assessed quality of life ( QOL ) in STC children before and after IFT treatment . METHODS Eligible STC children were r and omized to receive either real or placebo IFT ( 12 sessions for 4 weeks ) . Question naires ( Pediatric Quality of Life Inventory ) were administered before and 6 weeks after treatment , with parallel parent and child self-report scales . Higher scores indicate better QOL . Holschneider and Templeton scores were also obtained . The QOL scores were compared using paired t tests . RESULTS Thirty-three children ( 21 male ) , with a mean age of 11.8 years ( range , 7.4 - 16.5 years ) , were recruited ; 16 received real IFT .  Child-perceived QOL was improved after real IFT compared with baseline ( 81.1 vs 72.9 , P = .005 ) but not after placebo IFT ( 78.1 vs 74.9 , P = .120 ) . The Holschneider score improved after real IFT ( 10 vs 8 , P = .015 ) but not after placebo IFT ( 9 vs 8 , P = .112 ) . Parentally perceived QOL was similar after real IFT ( 70.1 vs 70.3 , P = .927 ) and placebo IFT ( 70.2 vs 69.8 , P = .899 ) . There were no differences in Templeton scores . CONCLUSION Interferential therapy is a novel therapy for children with STC that improves their self-perceived QOL PURPOSE This study aim ed to test the effectiveness of home transcutaneous electrical stimulation ( TES ) when patients with slow-transit constipation ( STC ) were trained by a naive clinician . METHODS A surgeon was trained to teach the TES method to STC children who then self-administered at home ( 1 hour a day , 3 - 6 months ) using a battery-powered interferential stimulator . Bowel diaries , PedsQL4.0 question naires , and radio-nuclear colonic transit studies were completed before and after treatment . RESULTS Thirty-two children ( 16 female ; mean age , 8.3 years ; range , 3 - 17 years ) self-administered 3 to 6 months of TES . Three did not return diaries . Group 1 ( n = 13 ) started with less than 3 bowel actions per week , and group 2 ( n = 16 ) , with more than 3 bowel actions per week . Defecation frequency increased in 69 % of group 1 ( mean , 1.4 - 3.0 per week ; P = .02 ) . Soiling frequency decreased in 50 % of group 2 ( 5.4 - 1.9 per week , P = .04 ) . Of 13 patients , 7 improved with development of urge-initiated defecation . Abdominal pain decreased in 48 % ( 1.6 episodes per week to 0.9 per week , P = .06 ) . Stool consistency improved in 56 % . There was significant improvement in child-reported and parent-reported PedsQL Scores . Colonic transit improved in 13 of 25 patients . CONCLUSION Home TES provides a new treatment for STC children , with 50 % of treatment-resistant patients benefited . Success requires clinician training and close patient contact . Transcutaneous electrical stimulation increased defecation and reduced soiling The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of  chronic constipation and obstructed defecation .  There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation .  Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre . Osmotic laxatives may be effective in patients who do not respond to fibre supplements . Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives . Controlled trials have shown that serotoninergic enterokinetic agents , such as prucalopride , and prosecretory agents , such as lubiprostone , are effective in the treatment of patients with chronic constipation .  Surgery is sometimes necessary . Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders , generalised motility disorders or psychological disorders . R and omised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation . Many surgical procedures may be used to treat  obstructed defecation in patients with acquired anatomical defects , but none is considered to be the gold st and ard . Surgery should be reserved for selected patients with an impaired quality of life .  Obstructed defecation is often associated with pelvic organ prolapse . Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse , but the efficacy and safety of such procedures have not yet been established 
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Conclusions This systemic review found moderate support for the effectiveness of electrical stimulation therapy in slow transit constipation in children .