***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: The aim of this study was to investigate if cognitive behavior therapy ( CBT ) based on exposure and mindfulness exercises delivered via the Internet would be effective in treating participants with irritable bowel syndrome ( IBS ) . Participants were recruited through self-referral . Eighty-six participants were included in the study and r and omized to treatment or control condition  ( an online discussion forum ) . One participant was excluded after r and omization . The main outcome measure was IBS-symptom severity and secondary measures included IBS-related quality of life , GI-specific anxiety , depression and general functioning . Participants were assessed at pre-treatment , post-treatment and 3 month follow-up ( treatment condition only ) . Four participants ( 5 % of total sample ) in the treatment condition did not participate in post-treatment assessment . Participants in the treatment condition reported a 42 % decrease and participants in the control group reported a 12 % increase in primary IBS-symptoms . Compared to the control condition , participants in the treatment group improved on all secondary outcome measures with a large between group effect size on quality of life ( Cohen 's d = 1.21 ) . We conclude that CBT-based on exposure and mindfulness delivered via the Internet can be effective in treating  IBS- patients  , alleviating the total burden of symptoms and increasing quality of life OBJECTIVES : Psychological and behavioral therapies are being increasingly used for symptom management in patients with irritable bowel syndrome ( IBS ) . The aims of this study were to compare two delivery modes for a comprehensive self-management ( CSM ) intervention , primarily by telephone vs. entirely in person , and to compare each with usual care ( UC ) . METHODS : Adults with IBS were recruited through community advertisement . Subjects ( N=188 ) were r and omly assigned to three groups : one in which all nine weekly CSM sessions were delivered in person , one in which six of the nine sessions were conducted over telephone , and one in which subjects received UC . Primary outcome measures were a gastrointestinal ( GI ) symptom score based on six symptoms from a daily diary and disease-specific quality of life ( QOL ) . These and other outcomes were assessed at baseline and at 3 , 6 , and 12 months after r and omization . Mixed model analyses tested for differences between the three groups in each outcome variable at the three follow-up occasions , controlling for the baseline level of each outcome . RESULTS : Both GI symptom score and QOL showed significantly greater improvement in the two CSM groups than in the UC group ( P<0.001 ) , with the magnitude of this difference being quite similar for the three follow-up time points . The two CSM groups experienced a very similar degree of improvement , and there were no statistically significant differences between the two . CONCLUSIONS : A CSM program is efficacious whether delivered primarily by telephone or totally in person , and there is no evidence that replacing six of the in-person sessions by telephone sessions reduces the efficacy of the intervention Objectives : Tenapanor is a first-in-class , small-molecule inhibitor of the gastrointestinal sodium/hydrogen exchanger NHE3 . This study assessed the efficacy and safety of tenapanor in patients with constipation-predominant irritable bowel syndrome ( IBS-C ) . Methods : In this phase 2 , double-blind study , patients with IBS-C ( Rome III criteria ) were r and omized ( 1:1:1:1 ) to receive tenapanor 5 mg , 20 mg , or 50 mg b.i.d . , or placebo b.i.d . for 12 weeks . The primary end point was the complete spontaneous bowel movement ( CSBM ) responder rate , defined as the proportion of patients reporting an increase from baseline of ≥1 CSBM/week for ≥6/12 treatment weeks . Secondary end points included abdominal symptom responder rates ( ≥30 % score improvement from baseline for ≥6/12 weeks ) and a composite responder rate ( CSBM and abdominal pain response in the same week for ≥6/12 weeks ) . Results : Overall , 356 patients were r and omized ( mean age : 45.7 years ; 86.8 % women ) and 304 completed the study .  The CSBM responder rate was significantly higher in the tenapanor 50 mg b.i.d . group than in the placebo group ( 60.7 vs. 33.7 % ; P<0.001 ) , as was the composite responder rate ( 50.0 vs. 23.6 % ; P<0.001 ) . Responder rates for abdominal symptoms ( pain , discomfort , bloating , cramping , and fullness ) were significantly higher in the tenapanor 50 mg b.i.d . group than in the placebo group ( all P<0.05 ) . Diarrhea was the most frequent adverse event ( tenapanor b.i.d . : 20 mg , 12.4 % ; 50 mg , 11.2 % ) . Conclusions : Tenapanor 50 mg b.i.d . significantly increased stool frequency and reduced abdominal symptoms in patients with IBS-C. Further research into tenapanor as a potential treatment for these patients is justified Twenty patients with irritable bowel syndrome ( IBS ) were r and omly assigned either to intensive , individualized cognitive therapy ( 10 sessions over 8 weeks ) or to 8 weeks of daily gastrointestinal ( GI ) symptom monitoring . Pre- to posttreatment evaluations showed significantly ( p = .005 ) greater GI symptom reduction for those receiving cognitive therapy than for those in symptom monitoring . At posttreatment , 80 % of the cognitive therapy group showed clinical ly significant improvement , whereas only 10 % of the monitoring group showed this . Results held up well at a 3-month follow-up . Within the cognitive therapy group , GI symptom reductions correlated significantly with increases in positive and reductions in negative automatic thoughts Background The heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose OBJECTIVES : Two identical , phase 3 , r and omized , double‐blind , placebo‐controlled trials evaluated the efficacy and safety of plecanatide in patients with irritable bowel syndrome with constipation ( IBS‐C ) . METHODS : Adults meeting Rome III criteria for IBS‐C were r and omized ( 1:1:1 ) to placebo or plecanatide ( 3 or 6 mg ) for 12 weeks . The primary efficacy end point was the percentage of overall responders ( patients reporting ≥30 % reduction from baseline in worst abdominal pain plus an increase of ≥1 complete spontaneous bowel movement (CSBM)/week from baseline in the same week for ≥6 of 12 treatment weeks ) . Safety was assessed by adverse events ( AEs ) . RESULTS : Overall , 2189 individuals were r and omized across the two studies and 1879 completed the studies . Demographic and baseline characteristics were similar across treatment groups and between studies . The percentage of overall responders in Study 1 was 30.2 % and 29.5 % for plecanatide 3 and 6 mg , respectively , vs. 17.8 % placebo ( P < 0.001 for each dose vs. placebo ) , and in Study 2 was 21.5 % ( P = 0.009 ) and 24.0 % ( P < 0.001 ) for plecanatide 3 and 6 mg , respectively , compared to 14.2 % for placebo . The percentage of sustained efficacy responders ( overall responders plus weekly responders for ≥2 of last 4 weeks of the 12‐week treatment period ) was significantly greater for both doses of plecanatide vs. placebo across both studies . All secondary end points ( stool frequency/consistency , straining , abdominal symptoms ) showed statistically significant improvements compared with placebo . The most common AE was diarrhea ( 3 mg , 4.3 % ; 6 mg , 4.0 % ; placebo , 1.0 % ) . Discontinuation due to diarrhea was infrequent ( 3 mg , 1.2 % ; 6 mg , 1.4 % ; placebo , 0 ) . CONCLUSIONS : Plecanatide significantly improved both abdominal pain and constipation symptoms of IBS‐C with minimal associated side effects and high levels of tolerability Background and objectives : We have previously shown that hypnosis can be used to study the effect of different emotions on the motility of the gastrointestinal tract . These studies demonstrated that both anger and excitement increased colonic motility while happiness led to a reduction . The purpose of this study was to investigate the effect of hypnotically induced emotion on the visceral sensitivity of the gut . Methods : Sensory responses to balloon distension of the rectum and compliance were assessed in 20 patients with irritable bowel syndrome ( IBS ) ( aged 17–64 years ; 17 female ) diagnosed by the Rome I criteria . Patients were studied on four separate occasions in r and om order either awake ( control ) or in hypnosis , during which anger , happiness , or relaxation ( neutral emotion ) were induced . Results : Hypnotic relaxation increased the distension volume required to induce discomfort ( p=0.05 ) while anger reduced this threshold compared with relaxation ( p<0.05 ) , happiness ( p<0.01 ) , and awake conditions ( p<0.001 ) . Happiness did not further alter sensitivity from that observed during relaxation . There were no associated changes in rectal compliance or wall tension . Conclusions : Further to our previous observations on motility , this study shows that emotion can also affect an IBS patient ’s perception of rectal distension and demonstrates the critical role of the mind in modulating gastrointestinal physiology . These results emphasise how awareness of the emotional state of the patient is important when either measuring visceral sensitivity or treating IBS OBJECTIVES : Psychological treatments are considered to be useful in the irritable bowel syndrome ( IBS ) , although the evidence is based on small , often flawed trials . Although cognitive behavior therapy ( CBT ) and relaxation therapy have both been promising , we hypothesized that CBT would be superior to relaxation and st and ard care alone in IBS patients . The objective of this study was to test this assumption by comparing the effects of cognitive behavior therapy with relaxation therapy and routine clinical care alone in individuals with IBS . METHODS : Patients ( n = 105 ) with Rome I criteria for IBS were recruited from advertisement ( n = 51 ) and outpatient clinics ( n = 54 ) ; those patients with resistant IBS were not included . A r and omized controlled trial with three arms ( st and ard care for all groups plus either CBT or relaxation ) for 8 wk was conducted , which applied blinded outcome assessment s using vali date d measures with 1 yr of follow-up . The primary outcome for this study was bowel symptom severity . RESULTS : Of 105 patients at the commencement of treatment , the mean bowel symptom frequency score for the whole sample was 21.1 and at the end of treatment had fallen to 18.1 ; this persisted at the 52-wk follow-up , with a significant linear trend for scores to change over time ( F= 39.57 p < 0.001 ) . However , there were no significant differences among the three treatment conditions . Significant changes over time were found for physical functioning ( F= 4.37 , p < 0.001 ) , pain ( F= 3.12 , p < 0.05 ) , general health ( F= 2.71 , p < 0.05 ) , vitality ( F= 2.94 , p < 0.05 ) , and the social functioning scales on the Medical Outcomes Study Short Form 36 ( F= 4.08 , p < 0.05 ) ; however , all three arms showed similar improvement . There were significant reductions in anxiety , depression , and locus of control scales , but no significant differences among the treatment groups were detected . CONCLUSION : Cognitive behavior and relaxation therapy seem not to be superior to st and ard care alone in IBS CONTEXT Chronic tension-type headaches are characterized by near-daily headaches and often are difficult 
    Output:
    
After completion of therapy , among trials recruiting only patients with refractory symptoms , group CBT and gut-directed hypnotherapy were more efficacious than either education and /or support or routine care , and CBT via the telephone , contingency management , CBT via the internet and dynamic psychotherapy were all superior to routine care .
Several psychological therapies are efficacious for IBS , although none were superior to another .
CBT-based interventions and gut-directed hypnotherapy had the largest evidence base and were the most efficacious long term .