***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: Eighty-nine patients who had been treated by ileal resection for Crohn 's disease between 1979 and 1984 were included in a prospect i ve cohort follow up to study the natural course of early postoperative lesions . Recurrent lesions were observed endoscopically in the neoterminal ileum within 1 year of surgery in 73 % of the patients , although only 20 % of the patients had symptoms . Three years after surgery , the endoscopic recurrence rate had increased to 85 % and symptomatic recurrence occurred in 34 % . The ultimate course of the disease was best predicted by the severity of the early postoperative lesions , as observed at ileoscopy . Clinical parameters that influenced outcome were preoperative disease activity , the indication for surgery , and the number of surgical resections . When patients were stratified for preoperative disease activity , the severity of lesions found at endoscopy remained a strong predictive factor for symptomatic recurrence . In 22 other patients su bmi tted to " curative " ileal resection and ileocolonic anastomosis , the segment to be used as neoterminal ileum was carefully examined during surgery , and two large biopsies were taken before making the anastomosis . An ileoscopy was performed 6 months after surgery . Although all patients had a macroscopically normal neoterminal ileum and 19 had entirely normal biopsies at the time of surgery , 21 patients were found at ileoscopy to have developed ileitis involving a 15-cm segment ( range , 4 - 30 cm ) , and 20 had unequivocal microscopic lesions on biopsies . These studies suggest that early lesions in the neoterminal ileum after Crohn 's resection do not originate from microscopic inflammation present in this bowel segment at the time of surgery . The early postoperative lesions in the neoterminal ileum seem to be a suitable model to study the pathogenesis of Crohn 's disease and also to evaluate new therapeutic modalities , either to prevent development of these early lesions or to treat progressive recurrence Background : Probiotics are efficacious for treating and maintaining remission of ulcerative colitis OBJECTIVES : VSL#3 is a high-potency probiotic mixture that has been used successfully in the treatment of pouchitis . The primary end point of the study was to assess the effects of supplementation with VSL#3 in patients affected by relapsing ulcerative colitis ( UC ) who are already under treatment with 5-aminosalicylic acid ( ASA ) and /or immunosuppressants at stable doses . METHODS : A total of 144 consecutive patients were r and omly treated for 8 weeks with VSL#3 at a dose of 3,600 billion CFU/day ( 71 patients ) or with placebo ( 73 patients ) . RESULTS : In all , 65 patients in the VSL#3 group and 66 patients in the placebo group completed the study . The decrease in ulcerative colitis disease activity index ( UCDAI ) scores of 50 % or more was higher in the VSL#3 group than in the placebo group ( 63.1 vs. 40.8 ; per protocol ( PP ) P=0.010 , confidence interval (CI)95 % 0.51–0.74 ; intention to treat ( ITT ) P=0.031 , CI95 % 0.47–0.69 ) . Significant results with VSL#3 were recorded in an improvement of three points or more in the UCDAI score ( 60.5 % vs. 41.4 % ; PP P=0.017 , CI95 % 0.51–0.74 ; ITT P=0.046 , CI95 % 0.47–0.69 ) and in rectal bleeding ( PP P=0.014 , CI95 % 0.46–0.70 ; ITT P=0.036 , CI95 % 0.41–0.65 ) , whereas stool frequency ( PP P=0.202 , CI95 % 0.39–0.63 ; ITT P=0.229 , CI95 % 0.35–0.57 ) , physician 's rate of disease activity ( PP P=0.088 , CI95 % 0.34–0.58 ; ITT P=0.168 , CI95 % 0.31–0.53 ) , and endoscopic scores ( PP P=0.086 , CI95 % 0.74–0.92 ; ITT P=0.366 , CI95 % 0.66–0.86 ) did not show statistical differences . Remission was higher in the VSL#3 group than in the placebo group ( 47.7 % vs. 32.4 % ; PP P=0.069 , CI95 % 0.36–0.60 ; ITT P=0.132 , CI95 % 0.33–0.56 ) . Eight patients on VSL#3 ( 11.2 % ) and nine patients on placebo ( 12.3 % ) reported mild side effects . CONCLUSIONS : VSL#3 supplementation is safe and able to reduce UCDAI scores in patients affected by relapsing mild-to-moderate UC who are under treatment with 5-ASA and /or immunosuppressants . Moreover , VSL#3  improves rectal bleeding and seems to reinduce remission in relapsing UC patients after 8 weeks of treatment , although these parameters do not reach statistical significance BACKGROUND & AIMS Saccharomyces boulardii is a probiotic yeast that has been shown to have beneficial effects on the intestinal epithelial barrier and digestive immune system . There is preliminary evidence that S boulardii could be used to treat patients with Crohn 's disease ( CD ) . We performed a r and omized , placebo-controlled trial to evaluate the effects of S boulardii in patients with CD who underwent remission during therapy with steroids or aminosalicylates .  METHODS We performed a prospect i ve study of 165 patients who achieved remission after treatment with steroids or salicylates ;  they were r and omly assigned to groups given S boulardii ( 1 g/day ) or placebo for 52 weeks . The primary end point was the percentage of patients in remission at week 52 . Time to relapse , Crohn 's disease activity index scores , and changes in parameters of inflammation were secondary end points . RESULTS CD relapsed in 80 patients , 38 in the S boulardii group ( 47.5 % ) and 42 in the placebo group ( 53.2 % , a nonsignificant difference ) . The median time to relapse did not differ significantly between patients given S boulardii ( 40.7 weeks ) vs placebo ( 39.0 weeks ) . There were no significant differences between groups in mean Crohn 's disease activity index scores or erythrocyte sedimentation rates or in median levels of C-reactive protein . In a post hoc analysis , nonsmokers given S boulardii were less likely to experience a relapse of CD than nonsmokers given placebo , but this finding requires confirmation . CONCLUSIONS Although the probiotic yeast S boulardii is safe and well tolerated , it does not appear to have any beneficial effects for patients with CD in remission after steroid or salicylate therapies AIM To investigate the effects of probiotic on intestinal mucosae of patients with ulcerative colitis ( UC ) , and to evaluate the role of probiotic in preventing the relapse of UC . METHODS Thirty patients received treatment with sulphasalazine ( SASP ) and glucocorticoid  and then were r and omly administered bifid triple viable capsule ( BIFICO ) ( 1.26 g/d ) , or an identical placebo ( starch ) for 8 wk . Fecal sample s were collected for stool culture 2 wk before and after the r and omized treatments . The patients were evaluated clinical ly , endoscopically and histologically after 2 mo of treatment or in case of relapse of UC . p65 and IkappaB expressions were determined by Western blot analysis . DNA-binding activity of NF-kappaB in colonic nuclear extracts was detected by electrophoretic mobility shift assay ( EMSA ) . mRNA expressions of cytokines were identified by semi-quantitative assay , reverse transcriptase- polymerase chain reaction ( RT-PCR ) . RESULTS Three patients ( 20 % ) in the BIFICO group had relapses during 2-mo follow-up period , compared with 14 ( 93.3 % ) in placebo group ( P<0.01 ) . The concentration of fecal lactobacilli , bifidobacteria was significantly increased in BIFICO-treated group only ( P<0.01 ) . The expressions of NF-kappaB p65 and DNA binding activity of NF-kappaB were significantly attenuated in the treatment group than that in control ( P<0.05 ) . The mRNA expression of anti-inflammatory cytokines was elevated in comparison with the control group . CONCLUSION The probiotic could impede the activation of NF-kappaB , decrease the expressions of TNF-alpha and IL-1beta and elevate the expression of IL-10 . These results suggest that oral administration of this new probiotic preparation is effective in preventing flare-ups of chronic UC . It may become a prophylactic drug to decrease the relapse of UC Background and aims : Experimental studies have shown that luminal bacteria may be involved in Crohn 's disease . Probiotics are a possible alternative to antibiotics . The aim of this r and omised placebo controlled study was to determine if Lactobacillus GG , given by mouth for one year , could prevent Crohn 's recurrent lesions after surgery or to reduce their severity . Methods : Patients operated on for Crohn 's disease in whom all of the diseased gut had been removed were r and omly allocated to receive 12 billion colony forming units of Lactobacillus or identical placebo for one year . Ileocolonoscopy was performed at the end of the trial or at the onset of symptoms . Endoscopic recurrence was defined as grade 2 or higher of Rutgeerts scoring system . Results : Eight of 45 patients were excluded from the trial ( three for non-compliance and five for protocol violations ) .  Clinical recurrence was ascertained in three ( 16.6 % ) patients who received Lactobacillus and in two ( 10.5 % ) who received placebo . Nine of 15 patients in clinical remission on Lactobacillus ( 60 % ) had endoscopic recurrence compared with six of 17 ( 35.3 % ) on placebo ( p=0.297 ) . There were no significant differences in the severity of the lesions between the two groups . Conclusions : Lactobacillus GG seems neither to prevent endoscopic recurrence at one year nor reduce the severity of recurrent lesions Background Experimental studies have shown that luminal antigens are involved in chronic intestinal inflammatory disorders such as Crohn 's disease and ulcerative colitis . Alteration of the intestinal microflora by antibiotic or probiotic therapy may induce and maintain remission . The aim of this r and omized , placebo-controlled trial was to determine the effect of oral Lactobacillus GG ( L. GG ) to induce or maintain medically induced remission . Methods Eleven patients with moderate to active Crohn 's disease were enrolled in this trial to receive either L. GG ( 2 × 109 CFU/day ) or placebo for six months . All patients were started on a tapering steroid regime and received antibiotics for the week before the probiotic/placebo medication was initiated . The primary end point was sustained remission , defined as freedom from relapse at the 6 months follow-up visit . Relapse was defined as an increase in CDAI of > 100 points . Results 5/11 patients finished the study , with 2 patients in each group in sustained remission . The median time to relapse was 16 ± 4 weeks in the L. GG group and 12 ± 4.3 weeks in the placebo group ( p = 0.5 ) . Conclusion In this study we could not demonstrate a benefit of L. GG in inducing or maintaining medically induced remission in CD Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research , derived from extensive review of published literature . When data that will withst and objective scrutiny are not available , a recommendation may be made based on a consensus of experts . Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty . Guidelines are intended to be flexible , not necessarily indicating the only acceptable approach , and should be distinguished from st and ards of care that are inflexible and rarely violated . Given the wide range of choices in any health-care problem , the physician should select the course best suited to the individual patient and the clinical situation presented . These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee . Expert opinion is solicited from the outset for the document . The quality of evidence upon which a specific recommendation is based is as follows : Grade A : Homogeneous evidence from multiple well- design ed r and omized ( therapeutic ) or cohort ( descriptive ) controlled trials , each involving a number of participants to be of sufficient statistical power . Grade B : Evidence from at least one large well- design ed clinical trial with or without r and omization , from cohort or case – control analytic studies , or well- design ed meta- analysis . Grade C : Evidence based on clinical experience , descriptive studies , or reports of expert committees . The Committee review s guidelines in depth , with participation from experienced clinicians and others in related fields . The final recommendations are 
    Output:
    
VSL#3 may be effective in inducing remission in active UC .
Probiotics may be as effective as 5-ASAs in preventing relapse of quiescent UC .