Dear Sir,

We thank Dr Pescatori for his letter [1] about our paper [2] and read with interest his personal experience on the effects of spinal cord stimulation on the electrical activity in the sigmoid colon.

Unfortunately, his experience with two neurological patients was not fully published in peer-reviewed journals which makes his report just an interesting but uncontrolled experience not easy to retrieve in PubMed to quote it. The methods used for electrical activity and bowel motility recording are not described and the procedure was probably performed on an unphysiological condition such as an artificially empty colon.

Electrical activity, particularly if not distally propagated (as shown in the picture from his letter) cannot explain an improvement in bowel transit of these patients, leaving the question still unanswered. Finally, since the author reports his experience with spinal cord stimulation this can not be described as the first report of sacral nerve stimulation.

Finally, we agree with Dr Pescatori about the possible psychological implications in these patients which are potential negative prognostic factors. Although these disturbances affect patients with obstructed type of constipation, they can sometimes be present in slow transit constipation, even if it is hard to understand whether they are the cause or the consequence of impaired bowel function.