***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 effect of open treatment with coarse wheat bran was compared with response to placebo , given in the form of a double blind , cross over drug trial , in patients with irritable bowel syndrome . Both bran and placebo significantly reduced the severity of most of the symptoms . Constipation was the only symptom that improved significantly with bran , but not with placebo , and was the only symptom that predicted a successful outcome with bran .  Diarrhoea did not improve with bran . In fact , stools became less formed in patients presenting with this symptom . The incidence of pain and urgency was significantly more frequent on bran compared with placebo . Compared with a baseline period , bran treatment result ed in an acceleration of whole gut transit time ( p less than 0.05 ) increases in daily stool weight ( p less than 0.01 ) and the proportion of unformed stools ( p less than 0.01 ) but no change in stool frequency .  Coarse wheat bran was no better than placebo for most symptoms in irritable bowel syndrome , although its efficacy in constipation was confirmed Background : Irritable bowel syndrome remains the commonest reason for referral to a gastroenterology clinic . Patients with irritable bowel syndrome are frequently advised to increase their intake of bran fibre , despite inconclusive experimental evidence of benefit The aims of this study were to determine ( a ) whether dietary fiber supplements modify symptoms in patients with irritable bowel syndrome , ( b ) the effect of fiber on rectosigmoid pressures , and ( c ) the relationship , if any , between rectosigmoid pressure and symptoms . Fourteen patients entered and 9 completed a double-blind , controlled , cross-over study of 7 mo duration . The mean age was 26 yr ( range , 18 - 37 ) . Patients received 4 cookies daily containing 20 mg corn fiber or placebo . Symptoms and compliance were evaluated monthly . Rectosigmoid pressures and dietary intake were evaluated at the outset and completion of each study arm . Symptoms improved during both fiber and placebo treatments . Those symptoms demonstrating significant improvement with time were pain severity , stool frequency , stool consistency ( p = 0.001 ) , number of additional gastrointestinal symptoms present ( p = 0.02 ) , and total symptom score ( p less than 0.001 ) . Rectosigmoid pressures were not significantly altered by fiber or placebo .  Fasting pressures at the distal recording site tended to correlate with pain severity ( r = 0.6 ; p = 0.06 ) . It was concluded that ( a ) corn fiber and placebo were both effective in alleviating symptoms , ( b ) there was a correlation between symptom severity and fasting rectosigmoid pressure , and ( c ) there was a trend toward reduction in fasting and postpr and ial rectosigmoid pressures after fiber therapy The aim of this study was to evaluate the effect of a novel laxative preparation , composed of cel and in , aloevera and psyllium in patients with chronic constipation . Thirty-five men and women were r and omized to receive capsules containing cel and in-aloevera-psyllium , or placebo , in a double-blind trial lasting 28 days . Symptoms in the last 2 weeks of the treatment period were compared to those in the 14-day pre-trial basal period . In the cel and in , aloevera and psyllium group , bowel movements became more frequent , the stools were softer and laxative dependence was reduced . In the placebo group , all these parameters were unchanged . Abdominal pain was not reduced in either group . The results of this study show that the preparation is an effective laxative in the treatment of constipation A double-blind controlled therapeutic trial of factorial design was used to study the therapeutic effects of lorazepam , hyoscine butylbromide , and ispaghula husk in 12 r and omised blocks of eight patients with the irritable bowel syndrome ( IBS ) . Each of the three agents caused a sustained symptomatic improvement in some of the patients , although only with ispaghula was the difference between the real and dummy preparation statistically significant . When the eight possible combinations of treatment were analysed none of the 12 patients who received only dummy preparations of the three agents had maintained any improvement over the three months of the trial . Seven patients improved among the 12 who received potent preparations of all three agents , and between four and six patients improved in the groups receiving one or two of the potent preparations . These therapeutic results , though far from perfect , show that the types of drug commonly used to treat IBS are of some value and may be additive in their effects . Similar combinations of other therapeutic agents may be more effective , but it will be possible to determine this only by carrying out factorial therapeutic trials This placebo controlled , double-blind , cross-over trial involving 20 patients was conducted to assess the effect of ispaghula husk on the major bowel symptoms and the whole gut transit time in irritable bowel syndrome ( IBS ) and to determine if changes in these parameters were related to global improvement . All 20 patients were interviewed at the end of the treatment periods and 14 patients kept concurrent daily records . Ispaghula therapy result ed in improvement in global symptoms and satisfying bowel movements ( P less than 0.001 ) but produced no change in abdominal pain or flatulence . There was a correlation between the improvement of well-being and the number of days of satisfying bowel movements ( P less than 0.001 ) but not with the indexes of pain , stool frequency or changes in the transit time . The easing of bowel dissatisfaction appears to be a major reason for the therapeutic success of ispaghula in IBS The effect of oral secoverine hydrochloride on neostigmine-stimulated sigmoid motility in 12 patients with irritable bowel syndrome was studied in a double-blind placebo-controlled cross-over study . Both spontaneous and stimulated motor activity were significantly reduced by the compound in comparison with placebo . The most sensitive indices were the frequency of wave activity , maximum amplitude and motility index . Two patients reported mild dizziness after secoverine 59 out patients with irritable bowel syndrome participated in a r and omised double-blind trial . The patients in the treatment group received three biscuits daily each containing 10 g of ordinary miller 's bran , whereas the patients in the control group received wheat biscuits of a similar appearance . The treatment period was 6 weeks . 52 % of the patients in the treatment group noted subjective improvement compared with 65 % in the control group . The results of this trial do not support the routine use of miller 's bran in irritable bowel syndrome Short-chain fatty acids ( SCFA ) in faeces were examined in 18 patients with the irritable bowel syndrome ( IBS ) during treatment with wheat bran or placebo .  In the placebo period , the patients could be classified in accordance with the faecal concentrations of SCFA into one group with low concentrations ( mean , 40 mmol/l ; range , 19 - 77 mmol/l ; 10 patients ) and another with high concentrations ( mean , 168 mmol/l ; range , 145 - 187 mmol/l ; 8 patients ) . The concentrations of SCFA differed ( P less than 0.001 ) in both groups from concentrations found in faeces from a reference group of nine normal individuals ( mean , 114 mmol/l ; range , 93 - 155 mmol/l ) . Patients with low levels of SCFA had lower ( P less than 0.001 ) mean stool mass and longer ( P less than 0.05 ) transit times than those with high concentrations of SCFA in faeces . Ingestion of bran , although a precursor of SCFA , did not change faecal concentrations of SCFA . Abdominal pain , distension , and rumbling were not correlated to low or high concentrations of SCFA in faeces , nor did bran improve these symptoms when compared to placebo . The level of SCFA was rather constant intraindividually and independent of the variability of the daily faecal mass . It is concluded that patients with IBS apparently have continuously abnormal concentrations of SCFA in faeces , either high or low , which are unaffected by the treatment with bran and which hypothetically may be of pathophysiologic importance # # # 1.1 PURPOSE OF GUIDELINES These guidelines were compiled by a multidisciplinary group at the request of the chairman of the British Society of Gastroenterology 's Clinical Services Committee . The prime targets for these guidelines are consultant gastroenterologists , specialist registrars in training , and general practitioners . The purpose is to identify and inform the key decisions to be made in the management of patients thought to have functional diseases of the gut . As these comprise the commonest conditions seen by gastroenterologists , the working party represented a wide spectrum of practitioners in gastroenterology , including gastroenterologists from both district general hospitals and tertiary referral centres , as well as primary care practitioners , psychiatrists , psychologists , and dietitians . # # # 1.2 SPECIFIC DIFFICULTIES Compared with producing guidelines for the management of well defined diseases such as peptic ulcer where there is a clear disease entity , an obvious end point , and highly effective treatments , drawing up guidelines for functional gastroenterological disorders has had many difficulties . Clinical trials have been difficult to design as the conditions being treated are highly variable with many possible end points , and most therapies only marginally more effective than placebo . Early trials were difficult to evaluate because of inadequate patient definition so that many questions have yet to be addressed with good quality r and omised controlled clinical trials . Most of our recommendations are therefore supported by clinical experience rather than r and omised controlled clinical trials . Finally , because functional diseases , although potentially debilitating , are non-fatal there are few uniformly available audit measures such as mortality or survival times by which to judge or compare different treatment regimens in different areas of clinical practice . # # # 1.3 PROCESS OF GUIDELINE CREATION The co-chairmen were approached by the chairman of the British Society of Gastroenterology 's Clinical Services Committee and invited to form a working party . Members were chosen to be broadly representative of clinicians and academics with a long term interest and publication record in the The aim of this study was to evaluate the efficacy of cimetropium bromide , a new antimuscarinic compound , in relieving symptoms of patients with irritable bowel syndrome over a three month period . Seventy consecutive out patients were given cimetropium ( 50 mg tid ) or placebo according to a double blind , r and omised , parallel groups design . Symptoms were evaluated initially and at monthly intervals up to the end of the study period . One patient receiving placebo  withdrew because of treatment failure . Pain score decreased by 40 , 66 , 85 % in the cimetropium group , at the end of the first , second and third months respectively , compared with 26 , 32 and 52 % reductions among controls ( p = 0.0005 ) . At the end of treatment there was a 86 % reduction in the number of abdominal pain episodes per day in the cimetropium group compared with 50 % in the placebo group ( p = 0.001 ) . Constipation and diarrhoea scores decreased by 59 and 49 % in the cimetropium treated patients , compared with 37 and 39 % in controls , the differences between being not significant . At the end of the study 89 % of the patients treated with cimetropium considered themselves as globally improved as opposed to 69 % in the placebo group ( p = 0.039 ) . The corresponding 95 % confidence intervals for the differences between the proportion of improved patients in the two groups were from 11 % to 29 % . Six patients taking cimetropium complained of slight dry mouth . The results of this study showed that cimetropium bromide is effective in relieving pain in patients with irritable bowel syndrome Sixty per cent of the patients referred to two gastroenterological clinics and diagnosed as suffering from the irritable bowel syndrome ( IBS ) , were found to have significant  psychoneurotic morbidity  on the basis of the General Health Question naire . A double‐blind , completely r and omised , placebo controlled comparison of treatment with a combined anxiolytic/antidepressant ( Motipress ) found a significantly better effect of Motipress than placebo  on diarrhoea and abdominal pain . Detailed analysis of the results suggests that there is no direct relationship between psychoneurotic illness and IBS , but the presence of the former has an adverse effect on the shortterm outcome of the bowel disorder To evaluate the efficacy of otilonium bromide , a spasmolytic agent , in the treatment of  irritable bowel syndrome  using modern and vali date d diagnostic criteria ABSTRACT To determine the efficacy and tolerability of an enteric-coated peppermint-oil formulation ( Colpermin ) , a prospect i ve , r and omized , double-blind , placebo-controlled clinical study was conducted in 110 out patients ( 66 men and 44 women ; 18–70 yr old ) with symptoms of irritable bowel syndrome . Patients took one capsule ( Colpermin or placebo ) 3–4 times daily , 15–30 min before meals , for 1 month . Fifty-two patients on Colpermin and 49 on placebo completed the study . Forty-one patients on Colpermin ( 79 % ) experienced an alleviation of the severity of abdominal pain ( 29 were pain free ) ; 43 ( 83 % ) had less abdominal distension , 43 ( 83 % ) had reduced stool frequency , 38 ( 73 % ) had fewer borborygmi , and 41 ( 79 % ) had less flatulence . Corresponding figures for the placebo group were : 21 patients ( 43 % ) with reduced pain ( four were pain free ) , 14 ( 29 % ) with reduced distension , 16 ( 3 
    Output:
    
The evidence for efficacy of drug therapies for IBS is weak .
Although there is evidence of benefit for antispasmodic drugs for abdominal pain and global assessment of symptoms ; it is unclear whether anti-spasmodic subgroups are individually effective .
There is no clear evidence of benefit for antidepressants or bulking agents .