***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: 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 Irritable bowel syndrome ( IBS ) prevalence estimates are essential for measuring the importance of the problem and the burden of the illness . However , IBS diagnosis is based on clinical criteria which have changed over time . The aim of this study was to assess how the use of different diagnostic criteria influences estimated IBS prevalence and , in particular , to compare how this prevalence varies using the new Rome II criteria and previous diagnostic criteria . METHODS An epidemiological survey was conducted in the general population using personal interviews in a home setting .  Two thous and individuals stratified by gender , age , social class and geographic location were r and omly selected from the general population of Spain . Participants were classified as ' potential IBS subjects ' ( n = 281 ) or ' non-potential IBS subjects ' ( n = 1719 ) as a result of their response to a screening question regarding the presence of abdominal pain , constipation or diarrhoea . Thus , we estimated IBS prevalence according to the following diagnostic criteria : Manning , Rome I , Rome II , Drossman , Talley and Kay & Jorgensen . RESULTS Prevalences of IBS according to the Manning and Rome I criteria were 10.3 % and 12.1 % , respectively . These were higher than the prevalences obtained with the other criteria used , which varied from 2.1 % to 4.9 % . IBS was more prevalent in females than males irrespective of the criteria used ( the female : male ratio ranged from 2.33 to 4.33 ) . Subjects who fulfilled the Rome II , Drossman , Talley or Kay & Jorgensen criteria also fulfilled the Rome I and Manning criteria . However , between 44 % and 80 % of subjects who fulfilled the Rome I or Manning criteria did not fulfil the more stringent diagnostic criteria . CONCLUSIONS The prevalence of IBS varies enormously depending on the diagnostic criteria employed . Criteria based on the frequency of symptoms , such as the Rome II criteria , produce much lower prevalence values compared to criteria based solely on the presence of symptoms . In fact , more than two-thirds of subjects who fulfilled the Rome I criteria would not have been diagnosed with IBS if Rome II criteria had been employed 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 OBJECTIVES : It has been suggested that the variation in the prevalence of irritable bowel syndrome ( IBS ) may be due to the application of different diagnostic criteria . New criteria for IBS have been proposed ( Rome II ) . It is unknown whether persons meeting different criteria for IBS have similar psychological and symptom features . The aim of this study was to measure the prevalence of IBS according to Manning and Rome definitions of IBS and to evaluate the clinical and psychological differences between diagnostic categories . METHODS : A total of 4500 r and omly selected subjects , with equal numbers of male and female subjects aged ≥18 yr and representative of the Australian population , took part in this study . Subjects were mailed a question naire ( response rate , 72 % ) . Characteristics measured were gastrointestinal symptoms over the past 12 months , neuroticism and extroversion ( Eysenck Personality Question naire ) , anxiety and depression ( Delusions-Symptoms-States Inventory ) , mental and physical functioning ( SF-12 ) , and somatic distress ( Sphere ) . RESULTS : The prevalence for IBS according to Manning , Rome I , and Rome II was 4.4 % ( 95 % confidence interval [ CI ] = 3.5–5.1 % ) , 6.9 % ( CI 6.0–7.8 % ) , and 13.6 % ( CI 12.3–14.8 % ) , respectively . Only 12 persons with Rome I did not also meet Rome II criteria ; 196 persons with Manning criteria did not meet Rome II cut-offs . Having IBS regardless of which criteria were used was significantly associated with psychological morbidity , but psychological factors were not important in discriminating between diagnostic categories . However , pain and bowel habit severity independently discriminated between diagnostic groups . CONCLUSIONS : IBS is a relatively common disorder in the community . The new Rome II criteria may be unnecessarily restrictive in practice Background Irritable bowel syndrome is the most common disorder diagnosed by gastroenterologists . Although several r and omized‐controlled trials have assessed the therapeutic role of antidepressant drugs , there is insufficient evidence to support their use One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy , relaxation , and st and ard medical treatment compared with st and ard medical treatment alone .  Patients were only selected if their symptoms had not improved with st and ard medical treatment over the previous 6 months . At 3 months , the treatment group showed significantly greater improvement than the controls on both gastroenterologists ' and patients ' ratings of diarrhea and abdominal pain , but constipation changed little . Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress , whereas those with constant abdominal pain were helped little by this treatment . This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to st and ard medical treatment Objective Postpr and ial symptoms in irritable bowel syndrome are common and relate to an exaggerated motor and sensory component of the gastrocolonic response . We investigated whether this response can be affected by hypnotherapy . Methods We included 28 patients with irritable bowel syndrome refractory to other treatments . They were r and omized to receive gut-directed hypnotherapy 1 hour per week for 12 weeks ( N = 14 ) or were provided with supportive therapy ( control group ; N = 14 ) . Before r and omization and after 3 months , all patients underwent a colonic distension trial before and after a 1-hour duodenal lipid infusion .  Colonic sensory thresholds and tonic and phasic motor activity were assessed . Results Before r and omization , reduced thresholds after vs. before lipid infusion were seen in both groups for all studied sensations . At 3 months , the colonic sensitivity before duodenal lipids did not differ between groups . Controls reduced their thresholds after duodenal lipids for gas ( 22 ± 1.7 mm Hg vs. 16 ± 1.6 mm Hg , p < .01 ) , discomfort ( 29 ± 2.9 mm Hg vs. 22 ± 2.6 mm Hg , p < .01 ) , and pain ( 33 ± 2.7 mm Hg vs. 26 ± 3.3 mm Hg , p < .01 ) , whereas the hypnotherapy group reduced their thresholds after lipids only for pain ( 35 ± 4.0 mm Hg vs. 29 ± 4.7 mm Hg , p < .01 ) . The colonic balloon volumes and tone response at r and omization were similar in both groups . At 3 months , baseline balloon volumes were lower in the hypnotherapy group than in controls ( 83 ± 14 ml vs. 141 ± 15 ml , p < .01 ) . In the control group , reduced balloon volumes during lipid infusion were seen ( 141 ± 15 ml vs. 111 ± 19 ml , p < .05 ) , but not after hypnotherapy ( 83 ± 14 ml vs. 80 ± 16 ml , p > .20 ) . Conclusion Hypnotherapy reduces the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome . These effects may be involved in the clinical efficacy of hypnotherapy in IBS Background The efficacy of antidepressants in irritable bowel syndrome ( IBS ) is controversial . No trials have directly compared a tricyclic with a selective serotonin reuptake inhibitor . Our aim was to determine whether imipramine and citalopram are efficacious in IBS . Methods This was a r and omized , double-blind , placebo-controlled , parallel group pilot trial with imipramine ( 50 mg ) and citalopram ( 40 mg ) . Results Of 51 IBS patients r and omized , baseline characteristics were comparable among the treatment arms ; the majority was diarrhea-predominant . Adequate relief of IBS symptoms ( primary endpoint ) was similar for each treatment arm . Improvements in bowel symptom severity rating for interference ( P = 0.05 ) and distress ( P = 0.02 ) were greater with imipramine versus placebo , but improvements in abdominal pain were not . There was a greater improvement in depression score ( P = 0.08 ) and in the SF-36 Mental Component Score ( P = 0.07 ) , with imipramine . Citalopram was not superior to placebo . Approximately 20 % of the variance in scores was explained by treatment differences for abdominal pain , bowel symptom severity disability , depression and the mental component of the SF-36 . Conclusion Neither imipramine nor citalopram significantly improved global IBS endpoints over placebo Previous research from the United Kingdom has shown hypnotherapy to be effective in the treatment of irritable bowel syndrome ( IBS ) . The current study provides a systematic replication of this work in the United States . Six matched pairs of IBS patients were r and omly assigned to either a gut-directed hypnotherapy ( n=6 ) or to a symptom monitoring wait-list control condition ( n=6 ) in a multiple baseline across subjects design . Those assigned to the control condition were later crossed over to the treatment condition . Subjects were matched on concurrent psychiatric diagnoses , susceptibility to hypnosis , and various demographic features . On a composite measure of primary IBS symptoms , treatment was superior ( p=.016 ) to symptom monitoring . Results from the entire treated sample ( n=11 ; one subject was removed from analysis ) indicate that the individual symptoms of abdominal pain , constipation , and flatulence improved significantly . State and trait anxiety scores were also seen to decrease significantly . Results at the 2-month follow-up point indicated good maintenance of treatment gains . No significant correlation was found between initial susceptibility to hypnosis and treatment gain . A positive relationship was found between the incidence of psychiatric diagnosis and overall level of improvement Despite the accumulation of efficacy data for cognitive-behavioral treatment of Irritable Bowel Syndrome ( IBS ) , efforts to investigate methods for increasing access to psychological treatments are in their infancy . The current study examined the efficacy of self-administered treatment in comparison to a wait list control .  Twenty-eight participants monitored gastrointestinal ( GI ) symptoms and completed measures of quality of life ( QOL ) and psychological distress prior to r and omized assignment to self-help treatment or wait list .  Wait listed participants later received treatment . A 3 month post-treatment follow-up was included . Seven participants completed immediate treatment ; nine the wait list . The self-help treatment significantly decreased composite GI symptom scores in comparison to the wait list , but did not lead to significant improvements in QOL or distress 
    Output:
    
The RR of IBS symptoms persisting with antidepressants versus placebo was 0.66 ( 95 % CI , 0.57 to 0.78 ) , with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors .
Antidepressants are effective in the treatment of IBS .
There is less high- quality evidence for routine use of psychological therapies in IBS , but available data suggest these may be of comparable efficacy