***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: BACKGROUND Micro-inflammation is considered an element in the pathogenesis of irritable bowel syndrome ( IBS ) . High-sensitivity C reactive protein ( hs-CRP ) was previously shown to be higher in IBS compared to healthy controls , albeit within the normal range . Since probiotics may suppress micro-inflammation in the gut , we tested if they reduce symptoms and inflammatory markers ( hs-CRP and fecal calprotectin ( FC ) in diarrhea-predominant IBS ( IBS-D ) . The aim of this study was to assess the clinical and laboratory effects of BIO-25 , a multispecies probiotic , in women with IBS-D. METHODS A double-blind , placebo-controlled study . Following a 2-week run-in , eligible women were assigned at r and om to a probiotic capsule or an indistinguishable placebo , twice daily for 8 weeks . IBS symptoms and stool consistency were rated daily by Visual Analogue Scales ( VAS ) and the Bristol Stool Scale ( BSS ) . High-sensitivity C reactive protein was tested at baseline , 4 and 8 weeks . FC was tested at baseline and 8 weeks . KEY RESULTS One hundred and seventy-two IBS-D patients were recruited and 107 eligible patients were allocated to the  intervention  ( n=54 ) or placebo  ( n=53 ) group . All symptoms improved in both groups with no significant difference between them in symptom improvement , hs-CRP or FC levels . CONCLUSIONS & INFERENCES An 8-week treatment with BIO-25 improved symptoms in women with IBS-D , but was not superior to placebo . This rigorously design ed and executed study supports the findings of other studies that did not demonstrate superiority of probiotics over placebo in IBS . High quality clinical studies are necessary to examine the efficacy of other specific probiotics in IBS-D patients since data are still conflicting : No currently available treatment provides consistent relief of irritable bowel syndrome . Colonic sensory and motor function are modulated partly through 5HT3‐receptors AIM To determine the effects of Lactobacillus acidophilus NCFM on  irritable bowel syndrome ( IBS ) symptoms and quality of life ( QoL ) . METHODS In this r and omized triple-blind trial , adult IBS volunteers who were recruited according to Rome III criteria received 109 or 1010 colony-forming units of NCFM or placebo daily for 12 wk . IBS Symptom Severity Score ( IBS-SSS ) , which constituted the primary outcome , and secondary outcomes , including individual IBS symptoms , IBS-related QoL question naire , anxiety and depression , defecation frequency , and stool consistency , were assessed at baseline at the end of the 8-wk run-in period , after 4 and 12 wk of intervention , and after a 4-wk washout . RESULTS A total of 340 of 391 r and omized volunteers completed the trial .  IBS-SSS improved over 12 wk of treatment in all treatment groups , decreasing by a mean ± SD of 44.0 ± 80.2 , 50.8 ± 82.4 , and 48.3 ± 72.2 in the placebo , active low-dose , and active high-dose groups , respectively . Similarly , secondary outcomes did not differ between treatment groups . However , in a post hoc analysis of volunteers with moderate to severe abdominal pain  at baseline ( VAS > 35/100 ) , the treatment significantly reduced the sensation of abdominal pain . Pain scores fell by 20.8 ± 22.8 , 29.4 ± 17.9 , and 31.2 ± 21.9 in the placebo , active low-dose , and active high-dose groups , respectively ( P value for placebo vs combined active doses = 0.0460 ) . CONCLUSION NCFM  alleviates moderate to severe abdominal pain , consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression Background and Aim . The efficacy of supplementation treatment with two multispecies probiotic formulates on subjects diagnosed with IBS-C and the assessment of their gut microbiota were investigated . Methods . A r and omized , double-blind , three-arm parallel group trial was carried out on 150 IBS-C subjects divided into three groups ( F_1 , F_2 , and F_3 ) . Each group received a daily oral administration of probiotic mixtures ( for 60 days ) F_1 or F_2 or placebo F_3 , respectively . Fecal microbiological analyses were performed by  species-specific qPCR  to assess the different amount of probiotics . Results . The percentage of responders for each symptom was higher in the probiotic groups when compared to placebo group during the treatment period ( t60 ) and was maintained quite similar during the follow-up period ( t90 ) . Fecal analysis demonstrated that probiotics of the formulations increased during the times of treatment only in fecal DNA from subjects treated with F_1 and F_2 and not with F_3 , and the same level was maintained during the follow-up period . Conclusions . Multispecies probiotic supplementations are effective in IBS-C subjects and induce a different assessment in the composition of intestinal microbiota . This clinical study is registered with the clinical study registration number IS RCT N15032219 BACKGROUND Irritable bowel syndrome ( IBS ) is a common disorder in Iran with challenging treatment . Although trials have suggested that probiotics alleviate the complaints of patients with minimal side effects , they have not been investigated in Iranian adults . METHODS In a r and omized double-blind study , 108 eligible IBS patients ( Rome III Criteria ) aged 20 - 70 years who referred consecutively to a clinical center in Tehran with abdominal bloating from 2010 to 2012 received a combination probiotics or placebo twice daily for 4 weeks . The objective was to evaluate the efficacy and safety of a multi-strain probiotics combination . One week prior to and throughout the treatment , the participants recorded their abdominal symptoms on a daily basis , using visual analogue scale and reported satisfactory relief of general symptoms at the end of each week . Adverse events were evaluated by self-reporting and physical examination . Continuous variables were analyzed by independent t-test and chi-square was used for binomials . RESULTS The baseline characteristics were balanced ( 60 % female , mean age 36.7 ± 11.5 ) . A total of 97 ( 51 intervention , 46 control ) completed the treatment . Intention to treat analysis was done on 108 allocated subjects . 85 % of the probiotic group reported satisfactory relief of general symptoms compared with 47 % in the control group ( P < 0.01 ) . A reduction in abdominal bloating and pain with probiotic was superior to placebo [ -13.0 vs. -3.7 ( P < 0.01 ) , -8.2 vs. -2.1 ( P = 0.02 ) , respectively ] . No severe adverse drug reaction was seen in either group . CONCLUSIONS A 4-week period of treatment with the combination probiotics twice daily was safe , well tolerated , and effective in our patients . Further investigation is recommended for other subgroups of IBS . Trial Registration : I RCT .ir I RCT 2012071010230N1 Background Probiotics have treatment efficacy in irritable bowel syndrome ( IBS ) , but the exact mechanism remains obscure . One hypothesis is the mediation of melatonin levels , leading to changes in IBS symptoms . Aim The purpose of this study was to evaluate the effects of a probiotic , VSL#3 , on symptoms , psychological and sleep parameters , and pain sensitivity in IBS , and relate these parameters to in vivo melatonin levels . Methods Forty-two IBS patients were r and omly assigned to receive VSL#3 or placebo for 6 weeks . Subjects completed bowel and psychological question naires , underwent rectal sensitivity testing and saliva melatonin assays . Results Abdominal pain duration and distension intensity decreased significantly in the probiotic group , along with an increase in rectal distension pain thresholds . A correlation between increase in pain tolerance and improvement in abdominal pain scores ( r = 0.51 , p = 0.02 ) was seen with probiotic . There was an increase in salivary morning melatonin levels in males treated with VSL#3 , which correlated ( r = 0.61 ) with improved satisfaction in bowel habits . When grouped based on baseline diurnal melatonin levels , patients with normal diurnal fluctuations showed an increase in morning melatonin levels with VSL#3 treatment , which significantly correlated with improved satisfaction in bowel habits ( r = 0.68 ) . They also had reduced symptom severity scores and abdominal pain duration when treated with VSL#3 , as well as satisfaction with bowel movements and quality -of-life . Conclusions VSL#3 improved symptoms and increased rectal pain thresholds . Symptom improvement correlated with a rise in morning melatonin , significant in males and subjects with normal circadian rhythm . This suggests that probiotics may act by influencing melatonin production , hence modulating IBS symptoms , in individuals with a normal circadian rhythm BACKGROUND Irritable bowel syndrome ( IBS ) is characterized by heterogeneous pathophysiology and low response to treatment . Up to 60 % of IBS patients suffers from visceral hypersensitivity , which is associated with symptom severity and underlying pathophysiological mechanisms . Recently , positive effects of probiotics in IBS have been reported , but overall the response was modest . We performed a study in IBS patients , characterized by visceral hypersensitivity measured with the rectal barostat , aim ing to assess the effect of 6 weeks of multispecies probiotic mix on visceral pain perception . METHODS We conducted a r and omized , placebo-controlled , double-blind trial in forty Rome III IBS patients with visceral hypersensitivity . Prior to intake , patients kept a 2-week symptom diary and underwent a rectal barostat measurement . When hypersensitivity was confirmed , participation was allowed and patients received a multispecies probiotic with in vitro proven potential beneficial effects on mechanisms contributing to visceral hypersensitivity ( six different probiotic strains ; 10(9 ) cfu/g ) , or a placebo product of one sachet ( 5 g ) per day for 6 weeks . At the end of the intervention period , visceroperception and symptoms were reassessed . KEY RESULTS Thirty-five patients completed the trial . The percentage of patients with visceral hypersensitivity decreased significantly in the probiotic and placebo group ( 76.5 % and 71.4 % , respectively ; N.S. between groups ) . Improvement in pain scores and mean symptom score did not differ between the probiotic and placebo group . CONCLUSIONS & INFERENCES In this placebo-controlled trial in IBS patients with visceral hypersensitivity , no significant effect of a multispecies probiotic on viscerperception was observed . The study has been registered in the US National Library of Medicine ( http://www . clinical trials.gov , NCT00702026 ) Objectives : There has been an increasing interest in the role of fermentable oligo- , di- , and monosaccharides and polyols ( FODMAPs ) in irritable bowel syndrome ( IBS ) . We report results from the first r and omized controlled trial of the low FODMAP diet in US adults with IBS and diarrhea ( IBS-D ) . The objectives were to compare the efficacy of the low FODMAP diet vs. a diet based upon modified National Institute for Health and Care Excellence guidelines ( mNICE ) on overall and individual symptoms in IBS-D patients . Methods : This was a single-center , r and omized-controlled trial of adult patients with IBS-D ( Rome III ) which compared 2 diet interventions . After a 2-week screening period , eligible patients were r and omized to a  low FODMAP or mNICE diet for 4 weeks . The primary end point was the proportion of patients reporting adequate relief of IBS-D symptoms ≥50 % of intervention weeks 3–4 . Secondary outcomes included a composite end point which required response in both abdominal pain ( ≥30 % reduction in mean daily pain score compared with baseline ) and stool consistency ( decrease in mean daily Bristol Stool Form of ≥1 compared with baseline ) , abdominal pain and stool consistency responders , and other key individual IBS symptoms assessed using daily question naires . Results : After screening , 92 subjects ( 65 women , median age 42.6 years ) were r and omized . Eighty-four patients completed the study ( 45 low FODMAP , 39 mNICE ) . Baseline demographics , symptom severity , and nutrient intake were similar between groups . Fifty-two percent of the low FODMAP vs. 41 % of the mNICE group reported adequate relief of their IBS-D symptoms ( P=0.31 ) . Though there was no significant difference in the proportion of composite end point responders ( P=0.13 ) , the low FODMAP diet result ed in a higher proportion of abdominal pain responders compared with the mNICE group ( 51 % vs. 23 % , P=0.008 ) . Compared with baseline scores , the low FODMAP diet led to greater reductions in average daily scores of abdominal pain , bloating , consistency , frequency , and urgency than the mNICE diet . Conclusions : In this US trial , 40–50 % of patients reported adequate relief of their IBS-D symptoms with the low FODMAP diet or a diet based on modified NICE guidelines . The low FODMAP diet 
    Output:
    
Overall , the beneficial effects were more distinct in the trials using multi-strain supplements with an intervention of 8 weeks or more , suggesting that multi-strain probiotics supplemented over a period of time have the potential to improve IBS symptoms