***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 
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    ***EXAMPLES*** 
    Input: 33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks . 20 improved , 11 of whom lost almost all their symptoms . Short-term improvement was maintained for 3 months without further formal treatment . Hypnotherapy in groups of up to 8 patients was as effective as individual therapy OBJECTIVES : Gut-directed hypnotherapy has been found to be effective in  irritable bowel syndrome ( IBS ) .  However , r and omized , controlled studies are rare and few have been performed outside highly specialized research centers . The objective of this study was to study the effect of gut-directed hypnotherapy in IBS in different clinical setting s outside the traditional research units . METHODS : The study population included IBS patients refractory to st and ard management . In study 1 , patients were r and omized to receive  gut-directed hypnotherapy  ( 12 sessions , 1 h/week ) in psychology private practice s or supportive therapy , whereas patients were r and omized to receive gut-directed hypnotherapy  in a small county hospital or to serve as waiting list controls in study 2 . Gastrointestinal symptom severity and quality of life were evaluated at baseline , at 3 months follow-up and after 1 year . RESULTS : We r and omized 138 IBS patients refractory to st and ard management , 90 in study 1 and 48 in study 2 . In both the studies , IBS-related symptoms were improved at 3 months in the gut-directed hypnotherapy groups ( P<0.05 ) , but not in the control groups ( ns ) . In study 1 , a significantly greater improvement of IBS-related symptom severity could be detected in the gut-directed hypnotherapy group than in the control group ( P<0.05 ) , and a trend in the same direction was seen in study 2 ( P=0.17 ) . The results seen at 3 months were sustained up to 1 year . CONCLUSIONS : Gut-directed hypnotherapy is an effective treatment alternative for patients with refractory IBS , but the effectiveness is lower when the therapy is given outside the highly specialized research centers 30 patients with severe refractory irritable-bowel syndrome were r and omly allocated to treatment with either hypnotherapy or psychotherapy and placebo . The psychotherapy patients showed a small but significant improvement in abdominal pain , abdominal distension , and general well-being but not in bowel habit . The hypnotherapy patients showed a dramatic improvement in all features , the difference between the two groups being highly significant . In the hypnotherapy group no relapses were recorded during the 3-month follow-up period , and no substitution symptoms were observed Background / Aims Irritable bowel syndrome ( IBS ) is one of the most common functional gastrointestinal disorders and when compared to the vast knowledge pertaining to adults with IBS , very little is known about IBS in children and adolescents . We aim ed to explore the prevalence of IBS , identify symptoms and contributing factors and also to examine the efficacy of trimebutine maleate in children and adolescents . Methods The study involved 345 children and adolescents ( 4 - 18 years ) and parents were requested to fill in a question naire , Rome III criteria was used to diagnose IBS . To exclude organic disease , all patients underwent medical investigations . Half of the r and omly selected IBS patients were treated with trimebutine maleate while the rest of IBS patients were not . The IBS patients were reevaluated at the end of 3 weeks . Results The prevalence of IBS according to Rome III criteria in children and adolescents was 22.6 % and IBS with constipation was the predominant subtype . Back pain ( OR , 6.68 ) , headache ( OR , 4.72 ) and chronic fatigue ( OR , 3.74 ) were significantly higher in IBS group . The prevalence of IBS in both parents and depression in mothers was greater for the patient group than the healthy controls ( P < 0.0001 ) . The prevalence of functional dyspepsia in IBS group was 80.8 % and was significantly higher than control group . Clinical recovery was seen in 94.9 % of the trimebutine maleate group versus spontaneous recovery in 20.5 % of the non-medicated group . The difference was significant ( P < 0.0001 ) . Conclusions IBS is a common disorder in children and adolescents . IBS is closely associated with somatic and familial factors . Trimebutine maleate is effective for pediatric IBS patients 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 BACKGROUND & AIMS Functional abdominal pain ( FAP ) and irritable bowel syndrome ( IBS ) are highly prevalent in childhood . A substantial proportion of patients continues to experience long-lasting symptoms . Gut-directed hypnotherapy ( HT ) has been shown to be highly effective in the treatment of adult IBS patients . We undertook a r and omized controlled trial and compared clinical effectiveness of HT with st and ard medical therapy ( SMT ) in children with FAP or IBS . METHODS Fifty-three pediatric patients , age 8 - 18 years , with FAP ( n = 31 ) or IBS ( n = 22 ) , were r and omized to either  HT  or  SMT . Hypnotherapy consisted of 6 sessions over a 3-month period . Patients in the SMT group received st and ard medical care and 6 sessions of supportive therapy .  Pain intensity , pain frequency , and associated symptoms were scored in weekly st and ardized abdominal pain diaries at baseline , during therapy , and 6 and 12 months after therapy . RESULTS Pain scores decreased significantly in both groups : from baseline to 1 year follow-up , pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0 . Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group . Hypnotherapy was highly superior , with a significantly greater reduction in pain scores compared with SMT ( P < .001 ) . At 1 year follow-up , successful treatment was accomplished in 85 % of the HT group and 25 % of the SMT group ( P < .001 ) . CONCLUSIONS Gut-directed HT is highly effective in the treatment of children with longst and ing FAP or IBS OBJECTIVES : Gut-directed hypnotherapy ( GHT ) in individual sessions is highly effective in the treatment of irritable bowel syndrome ( IBS ) . This study aim ed to assess the long-term effect of GHT in group sessions for refractory IBS . METHODS : A total of 164 patients with IBS ( Rome-III- criteria ) were screened , and 100 refractory to usual treatment were r and omized 1:1 either to supportive talks with medical treatment ( SMT ) or to SMT with GHT ( 10 weekly sessions within 12 weeks ) . The primary end point was a clinical ly important improvement on several dimensions of daily life ( assessed by IBS impact scale ) after treatment and 12-month follow-up . The secondary end point was improvement in general quality of life ( QOL ; Medical Outcome Study Short-Form-36 ) , psychological status ( Hospital Anxiety Depression Scale ) and reduction of single IBS symptoms . Analysis was by intention to treat . RESULTS : A total of 90 patients received allocated intervention . After treatment , 28 ( 60.8 % ) out of 46 GHT patients and 18 ( 40.9 % ) out of 44 SMTs improved ( absolute difference 20.0 % ; 95 % confidence interval ( CI ) : 0–40.2 % ; P=0.046 ) ; over 15 months , 54.3 % of GHT patients and 25.0 % of controls improved ( absolute difference 29.4 % ; 95 % CI 10.1–48.6 % ; P=0.004 ) . GHT with SMT  improved physical and psychological well being significantly more than SMT alone ( P<0.001 ) . Gender , age , disease duration and IBS type did not have an influence on the long-term success of GHT . CONCLUSIONS : GHT improves IBS-related QOL , is superior to SMT alone , and shows a long-term effect even in refractory IBS Hypnosis improves  irritable bowel syndrome ( IBS ) , but the mechanism is unknown . Possible physiological and psychological mechanisms were investigated in two studies . Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home . Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients ( study I ) , and treatment changes in heart rate , blood pressure , skin conductance , finger temperature , and forehead electromyographic activity were assessed in 24 patients ( study II ) .  Somatization , anxiety , and depression were also measured . All central IBS symptoms improved substantially from treatment in both studies . Rectal pain thresholds , rectal smooth muscle tone , and autonomic functioning ( except sweat gl and reactivity ) were unaffected by hypnosis treatment . However , somatization and psychological distress showed large decreases . In conclusion , hypnosis improves IBS symptoms through reductions in psychological distress and somatization . Improvements were unrelated to changes in the physiological parameters measured BACKGROUND In western population s irritable bowel syndrome ( IBS ) affects between 10 % and 30 % of the population and has a significant effect on quality of life . It generates a substantial workload in both primary and secondary care and has significant cost implication s. Gut-directed hypnotherapy has been demonstrated to alleviate symptoms and improve quality of life but has not been assessed outside of secondary and tertiary referral centres . AIM To assess the effectiveness of gut-directed hypnotherapy as a complementary therapy in the management of IBS . DESIGN OF STUDY R and omised controlled trial . SETTING Primary care patients aged 18 - 65 years inclusive , with a diagnosis of IBS of greater than 6 weeks ' duration and having failed conventional management , located in South Staffordshire and North Birmingham , UK . METHOD Intervention patients received five sessions of hypnotherapy in addition to their usual management .  Control patients received usual management alone . Data regarding symptoms and quality of life were collected at baseline and again 3 , 6 , and 12 months post-r and omisation . RESULTS Both groups demonstrated a significant improvement in all symptom dimensions and quality of life over 12 months . At 3 months the intervention group had significantly greater improvements in pain , diarrhoea and overall symptom scores ( P<0.05 ) . No significant differences between groups in quality of life were identified . No differences were maintained over time . Intervention patients , however , were significantly less likely to require medication , and the majority described an improvement in their condition . CONCLUSIONS Gut-directed hypnotherapy benefits patients via symptom reduction and reduced medication usage , although the lack of significant difference between groups beyond 3 months prohibits its general introduction without additional evidence . A large trial incorporating robust economic analysis is , therefore , urgently recommended Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques . Since hypnosis can be used safely to induce specific emotional states of considerable intensity , we studied the effect on distal colonic motility of three hypnotically induced emotions ( excitement , anger , and happiness ) in 18 patients aged 20 - 48 years with irritable bowel syndrome .  Colonic motility index was reduced by hypnosis on its own ( mean change 19.1 ; 95 % CI 0.8 , 37.3 ; p less than 0.05 ) and this change was accompanied by decreases in both pulse ( 12 ; 8 , 15 ) and respiration ( 6 ; 4 , 8) rates ( p less than 0.001 for both ) . Anger and excitement increased the colonic motility index ( 50.8 ; 29.4 , 72.2 ; and 30.4 ; 8.9 , 51.9 , respectively ; p less than 0.01 for both ) , pulse rate ( 26 ; 22 , 30 ; and 28 ; 24 , 32 ; p less than 0.001 for both ) , and respiration rate ( 14 ; 12 , 16 ; and 12 ; 10 , 14 ; p less than 0.001 for both ) . Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone . Changes in motility were mainly due to alterations in rate than in amplitude of contractions . Our results indicate that hypnosis may help in the investigation of the effects of emotion on physiological functions ; this approach could be useful outside the gastrointestinal system . Our observation 
    Output:
    
This study provides clearer evidence that hypnotherapy has beneficial short-term effects in improving gastrointestinal symptoms of patients with IBS