***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: Abstract Objective . The effect of probiotics on IBS symptoms has been mixed , but remains an intriguing treatment option with appeal to the patient . Material and methods . Patients fulfilling the Rome II criteria were r and omized double-blind to a daily intake of 500 ml of fermented milk containing at least 5 × 107 CFU/ml of Lactobacillus paracasei ssp paracasei F19 , Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 or an equal volume of acidified milk for 8 weeks . Symptoms were assessed at baseline and weekly using a disease-specific vali date d symptom rating scale ( IBS-SSI ) . The predefined primary outcome measure was patient reported adequate symptom relief . Adherence to study protocol were assessed by performing stool sample s at the of the treatment period . Results . Eight-one patients were screened . Sixty-four patients were r and omized ; 18 patients did not complete the study due to protocol violations or withdrew due to lack of effect . Fifty-two patients ( 13 males ) completed the study as per protocol ; mean age was 51.3 years ( range 29–67 ) . The proportion of patients reporting adequate symptom relief increased in both patient groups , but there was not any statistical difference between the groups . IBS-SSI scores did not differ statistically between the groups at the end of the treatment period , but improved during the study period in both groups . Conclusions . During this 8-week trial gastrointestinal symptoms improved . However , there was no difference between treatment with fermented milk containing probiotics or acidified milk . The effect of probiotics on IBS symptoms remains uncertain and further studies are warranted BACKGROUND & AIMS Few treatments have demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome ( IBS-D ) . A phase 3 , r and omized , double-blind , placebo-controlled trial was performed to evaluate the safety and efficacy of repeat treatment with the nonsystemic antibiotic rifaximin . METHODS The trial included adults with IBS-D , mean abdominal pain and bloating scores of 3 or more , and loose stool , located at 270 centers in the United States and Europe from February 2012 through June 2014 . Those responding to a 2-week course of open-label rifaximin  550 mg 3 times daily , who then relapsed during an observation phase ( up to 18 weeks ) , were r and omly assigned to groups given repeat treatments of rifaximin 550 mg or placebo 3 times daily for 2 weeks . The primary end point was percentage of responders after first repeat treatment , defined as a decrease in abdominal pain of ≥30 % from baseline and a decrease in frequency of loose stools of ≥50 % from baseline , for 2 or more weeks during a 4-week post-treatment period . RESULTS Of 1074 patients ( 44.1 % ) who responded to open-label rifaximin , 382 ( 35.6 % ) did not relapse and 692 ( 64.4 % ) did ; of these , 636 were r and omly assigned to receive repeat treatment with rifaximin ( n = 328 ) or placebo ( n = 308 ) . The percentage of responders was significantly greater with rifaximin than placebo ( 38.1 % vs 31.5 % ; P = .03 ) . The percentage of responders for abdominal pain ( 50.6 % vs 42.2 % ; P = .018 ) was significantly greater with rifaximin than placebo , but not stool consistency ( 51.8 % vs 50.0 % ; P = .42 ) . Significant improvements were also noted for prevention of recurrence , durable response , and bowel movement urgency . Adverse event rates were low and similar between groups . CONCLUSIONS In a phase 3 study of patients with relapsing symptoms of IBS-D , repeat rifaximin treatment was efficacious and well tolerated . Clinical Trials.gov ID : NCT01543178 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 Several studies with probiotics have shown promising results in the treatment of IBS . One of the probiotics used was saccharomyces boulardii . This is a r and omized double blind placebo controlled clinical trial of S. boulardii in diarrhoea predominant IBS and was carried out in the hospital of Bangab and hu Sheikh Mujib Medical University ( BSMMU ) , Dhaka , Bangladesh from June 2004 to July 2005 . Thirty five ( 35 ) patients were included in each of the control and study groups . The study group was treated with S. boulardii 250 mg twice daily orally for one month . Patients were evaluated before therapy , at the end of therapy and 30 days after end of therapy by a scoring system which included symptoms as well as personal and professional life . No significant difference between the two groups was found in any of the parameters evaluated on any of the observation days . S. boulardii treatment for 30 days in diarrhoea predominant IBS patients did not result in any improvement in this study Context Few trials have evaluated the effects of antibiotics on symptoms of the irritable bowel syndrome ( IBS ) .  Contribution In this double-blind trial , 87 patients with IBS were r and omly assigned to either rifaximin ( 400 mg 3 times daily ) or placebo for 10 days . Over a 10-week follow-up period , the rifaximin recipients reported global improvements in overall symptoms and less bloating more frequently than the placebo recipients . No major differences in abdominal pain , diarrhea , or constipation were observed between the groups . Caution s The duration of therapy and follow-up was short . Implication s Rifaximin may improve some symptoms in some patients with IBS . The Editors The irritable bowel syndrome ( IBS ) is one of the most common chronic medical conditions ( 16 ) , yet its cause is unknown . Among other contributors , alterations in gut flora have been identified as potentially important . Results of recent studies indicate that up to 84 % of patients with IBS have an abnormal lactulose breath test result , suggesting small-intestinal bacterial overgrowth ( 7 , 8) . On the basis of this concept , the antibiotic neomycin can statistically significantly improve the symptoms of IBS ( 7 , 8) . In addition , the effect of neomycin correlates with the elimination of bacterial overgrowth , as indicated by the normalization of the lactulose breath test result ( 7 , 8) . Although neomycin seems to improve symptoms , it effectively eliminates bacterial overgrowth in only about 25 % of patients with IBS ( 8) . Furthermore , side effects limit the use of neomycin . Low efficacy also applies to other antibiotics ( for example , doxycycline and amoxicillinclavulanate ) that have been previously investigated for treating bacterial overgrowth ( 9 ) . An ideal antibiotic for IBS is , arguably , one with negligible systemic absorption , minimal side effects , and high efficacy for bacterial overgrowth . Rifaximin is a gut-selective antibiotic with negligible systemic absorption ( 0.4 % ) and broad-spectrum activity in vitro against gram-positive and gram-negative aerobes and anaerobes ( 10 ) . On the basis of this broad spectrum , eradication rates with rifaximin  in bacterial overgrowth are as high as 70 % ( 11 ) . Furthermore , rifaximin has a similar tolerability profile to that of placebo and has known activity against Clostridium difficile ( 12 ) . These properties make it a good c and i date for treating a condition that is as common as IBS . Our study aim ed to determine whether the nonabsorbed antibiotic rifaximin is more effective than placebo in reducing symptoms in adults with IBS . Methods Setting and Participants Our study was conducted at the Cedars-Sinai Medical Center , Los Angeles , California , and the University of Chicago , Chicago , Illinois . We recruited patients with IBS through advertising in local media ( radio and news publications ) . We did not recruit patients from the IBS clinics of the Cedars-Sinai Gastrointestinal Motility Program to avoid enrollment of tertiary care patients . The institutional review board of both centers approved the study , and all patients provided written informed consent . Patients between 18 and 65 years of age who met Rome I criteria ( 13 ) were eligible . Exclusion criteria were the presence of underlying conditions that are known to predispose to bacterial overgrowth , including diabetes ; narcotic use ; previous bowel resection ; inflammatory bowel disease ; cirrhosis ; known bowel adhesions ; or any known chronic gastroenterological disease , such as celiac disease . We excluded patients who were taking tegaserod and antidepressants  unless these treatments were discontinued before study entry . We also excluded participants who reported taking an oral antibiotic within the previous 3 months . After participant inclusion and exclusion , we recruited 84 participants from the Cedars-Sinai Medical Center and 3 participants from the University of Chicago . We followed participants in special research clinics at both centers . R and omization and Interventions Eligible patients completed a 7-day stool diary that was based on the Bristol stool form scale ( 14 ) . Patients returned to the clinic after a 12-hour fast and completed a symptom question naire about the preceding 7 days of symptoms . We then r and omly assigned patients to double-blind treatment with 400 mg of rifaximin 3 times daily for 10 days or a matching placebo . We chose this dosage on the basis of a previous study that demonstrated the efficacy of rifaximin in bacterial overgrowth ( 11 ) . The r and omization of rifaximin versus placebo was conducted outside of Cedars-Sinai Medical Center in a 1:1 ratio into blocks of 4 patients . The allocation sequence was determined and coded at Salix Pharmaceuticals , Morrisville , North Carolina . Since this was an investigator-initiated study , the rifaximin and placebo were distributed to the Cedars-Sinai Medical Center , and nonstratified medicine and placebo were sent to the University of Chicago in groups of 4 as enrollment progressed . The medicine and placebo were prepackaged to conceal content at all times . Research personnel who were involved in product distribution were also blinded to package content . Assessment s and Follow-up After completing the 10-day course of study medication , patients immediately began another stool diary for 7 days then returned to complete a follow-up question naire and to return their pill container for a pill count to determine adherence . Patients then entered the follow-up phase , during which they completed a weekly self-administered symptom question naire at home that documented their symptoms for an additional 9 weeks ( for a total of 10 weeks of post-treatment follow-up ) . During this time , we asked participants to fax their responses to the research office . When a fax was not received on the appropriate day , research assistants called patients to ensure adherence . During this phase of study , no physician interaction occurred . During the last week of follow-up , patients completed a daily stool diary . At the end of the follow-up period , patients returned to the clinic for a final visit , which included another symptom question naire . For the initial symptom question naire , patients were asked to indicate the severity of each of 9 symptoms ( abdominal pain , diarrhea , constipation , bloating , urgency , incomplete evacuation , mucus , sense of incomplete evacuation , and gas ) on a visual analogue scale ( VAS ) ranging from 0 mm to 100 mm , with 100 mm being extreme . We used all 9 symptoms to verify IBS criteria in patients , but we assigned only diarrhea , constipation , abdominal pain , and bloating a priori as treatment end points . We asked patients to rate the severity of their symptoms on the VAS again 7 days after the completion of rifaximin treatment or place 
    Output:
    
Particular combinations of probiotics , or specific species and strains , appeared to have beneficial effects on global IBS symptoms and abdominal pain , but it was not possible to draw definitive conclusions about their efficacy .
Adverse events were no more common with probiotics or antibiotics .
Which particular combination , species or strains of probiotics are effective for IBS remains , for the most part , unclear .
Rifaximin has modest efficacy in improving symptoms in non-constipated IBS