***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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    Input: AIM To evaluate the effects of a combination probiotic on symptoms and colonic transit in patients with irritable bowel syndrome ( IBS ) and significant bloating . METHODS Forty-eight patients with Rome II IBS were r and omized in a parallel group , double-blind design to placebo or VSL # 3 twice daily ( 31 patients received 4 weeks and 17 patients 8 weeks of treatment ) . Pre- and post-treatment colonic transit measurements were performed using scintigraphy with (111)In charcoal . Symptoms were summarized as an average daily score for the entire period of treatment and separately for the first 4 weeks of treatment . Weekly satisfactory relief of abdominal bloating was assessed . RESULTS Treatment with VSL # 3 was associated with reduced flatulence over the entire treatment period ( placebo 39.5 + /- 2.6 vs VSL # 3 29.7 + /- 2.6 , P = 0.011 ) ; similarly , during the first 4 weeks of treatment , flatulence scores were reduced ( placebo 40.1 + /- 2.5 vs VSL # 3 30.8 + /- 2.5 , P = 0.014 ) . Proportions of responders for satisfactory relief of bloating , stool-related symptoms , abdominal pain and bloating scores were not different . Colonic transit was retarded with VSL # 3 relative to placebo ( colon geometric center 2.27 + /- 0.20 vs 2.83 + /- 0.19 , P = 0.05 respectively ) . CONCLUSION VSL # 3 reduces flatulence scores and retards colonic transit without altering bowel function in patients with IBS and bloating OBJECTIVE Experimental and clinical studies have shown that a novel symbiotic ( known as SCM-III ) exerts a beneficial effect on gut translocation and local and systemic inflammatory and microbial metabolic parameters . The present investigation was a preliminary trial on the effectiveness of SCM-III for irritable bowel syndrome ( IBS ) . METHODS Sixty-eight consecutive adult patients with IBS who were free from lactose malabsorption , abdominal surgery , overt psychiatric disorders and ongoing psychotropic drug therapy or ethanol abuse were studied prospect ively and divided into 2 groups that were comparable for age , gender , body size , education and pattern of presenting symptoms . The 2 groups were blindly given for 12 weeks either SCM-III 10 mL t.i.d or the same dosage of heat-inactivated symbiotic . RESULTS Treatment with SCM-III was ' effective ' or ' very effective ' in more than 80 % of the patients ( P < 0.01 vs baseline values and control ) . Less than 5 % reported ' not effective ' as the final evaluation compared with over 40 % of patients in the control group . After 6 weeks of treatment , a significant improvement of pain and bloating was reported in the treatment group compared with control and baseline values . There was also a benefit for bowel habits , mostly for patients with constipation or alternating bowel habits . No overt clinical or biochemical adverse side-effects were recorded . CONCLUSION Compared with baseline values and the control group , SCM-III result ed in a significant increase in lactobacilla , eubacteria and bifidobacteria , which suggests that some selected IBS patients could benefit substantially from symbiotics , but the treatment may need to be given on a cyclic schedule because of the temporary modification of the fecal flora BACKGROUND & AIMS We have recently documented the efficacy of a highly concentrated probiotic preparation ( VSL#3 ) in the prevention of flare-up in patients with chronic pouchitis . The aim of this study was to compare probiotic therapy with VSL#3 versus placebo in the ability to prevent the onset of acute pouchitis during the first year after ileal pouch-anal anastomosis . METHODS Forty consecutive patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were r and omized to receive either VSL#3 ( 1 packet containing 900 billion bacteria/day ) ( n = 20 ) or an identical placebo ( n = 20 ) immediately after ileostomy closure for 1 year . The patients were assessed clinical ly , endoscopically , and histologically after 1 , 3 , 6 , 9 , and 12 months . Health-related quality of life was assessed using the Inflammatory Bowel Disease Question naire . RESULTS Two of the 20 patients ( 10 % ) treated with VSL#3 had an episode of acute pouchitis compared with 8 of the 20 patients ( 40 % ) treated with placebo ( log-rank test , z = 2.273 ; P < 0.05 ) . Treatment with VSL#3 determined a significant improvement in Inflammatory Bowel Disease Question naire score , whereas this was not the case with placebo . CONCLUSIONS Treatment with VSL#3 is effective in the prevention of the onset of acute pouchitis and improves quality of life of patients with ileal pouch-anal anastomosis Background : Ten to 15 % of patients with pouchitis experience refractory or recurrent disease . The aim of this study was to evaluate the effectiveness of a single daily high dose probiotic preparation ( VSL#3 ) in maintaining antibiotic induced remission , and quality of life ( QOL ) , for one year in such patients . Methods : Patients with pouchitis at least twice in the previous year or requiring continuous antibiotics , associated with a pouchitis disease activity index ( PDAI ) ⩾7 ( 0 = perfect ; 18 = worst ) , in whom remission was induced by four weeks of combined metronidazole and ciprofloxacin  , were r and omised to receive VSL#3 6 g or placebo once daily for one year or until relapse . Symptomatic , endoscopic , and histological evaluations were made before , and two and 12 months after r and omisation or at the time of relapse . Remission was defined as a clinical PDAI ⩽2 and endoscopic PDAI ⩽1 . Relapse was defined as an increased clinical PDAI score ⩾2 and increased endoscopic PDAI score ⩾3 . QOL was assessed using the inflammatory bowel disease question naire ( IBDQ ) . Results : Thirty six patients were r and omised : 20 to VSL#3 and 16 to  placebo . Remission was maintained at one year in 17 patients ( 85 % ) on VSL#3 and in one patient ( 6 % ) on placebo ( p<0.0001 ) . The IBDQ score remained high in the VSL#3 group ( p = 0.3 ) but deteriorated in the placebo group ( p = 0.0005 ) . Conclusion : The once daily high dose probiotic VSL#3 is effective in maintaining antibiotic introduced remission for at least a year in patients with recurrent or refractory pouchitis . This is associated with a high level of quality of life Irritable Bowel Syndrome ( IBS ) may be diagnosed on the presence of symptoms , according to Rome II criteria and some studies have shown that abnormal colonic fermentation may be an important factor in the development of symptoms in some patients with IBS . Since the fermentations of substrates by the intestinal flora may play a key role in the use of probiotics in the treatment of IBS , fifty patients ( 24 males,26 females ) , mean age 40 years ( range = 26–64 years ) with IBS , according to Rome II criteria , were enrolled into the study after informed consensus . Patients were r and omly assigned to receive either the active preparation containing Lactobacillus Plantarum LP0 1 and Bifidocterium Breve BR0 both at a concentration of 5 × 109 CFU/ml , or placebo powder containing starch identical to the study product , for 4 weeks . To evaluate treatment efficacy two different scores were considered : Pain score in different abdominal locations after treatment decreased in probiotics group of 38 % versus 18 % ( P < 0.05 ) of placebo group after 14 days and of 52 % versus 11 % ( P < 0.001 ) after 28 days . The severity score of characteristic IBD symptoms significantly decreased in probiotic group versus placebo group after 14 days 49.6 % versus 9.9 % ( P < 0.001 ) and these data were confirmed after 28 days ( 44.4 % versus 8.5 % , P < 0.001 ) . In conclusion , short-term therapy with Lactobacillus PlantarumLP0 1 and Bifidocterium Breve BR0 may be considered a promising approach to the therapy for IBS To investigate the efficacy and safety of tegaserod , a novel 5‐HT4 receptor partial agonist , in a r and omized , double‐blind , placebo‐controlled , 12‐week treatment , multicentre study Background : Irritable bowel syndrome is a gastrointestinal disorder of unknown aetiology . The effect of probiotics in this syndrome remains unclear Background and aims : Chronic bowel disturbances resembling irritable bowel syndrome ( IBS ) develop in approximately 25 % of patients after an episode of infectious diarrhoea . Although we have previously shown that psychosocial factors operating at the time of , or prior to , the acute illness appear to predict the development of post-infectious IBS ( PI-IBS ) , our finding of an increased inflammatory cell number in the rectum persisting for at least three months after the acute infection suggested that there is also an organic component involved in the development of PI-IBS . To evaluate this further , we measured expressions of interleukin 1β ( IL-1β ) and its receptor antagonist ( IL-1ra ) in these patients to provide additional evidence that the pathogenesis of PI-IBS is underpinned by an inflammatory process . Methods : Sequential rectal biopsy sample s were prospect ively obtained during and three months after acute gastroenteritis , from eight patients who developed post-infectious IBS ( INF-IBS ) and seven patients who returned to normal bowel habits after acute gastroenteritis ( infection controls , INF-CON ) . Eighteen healthy volunteers who had not suffered from gastroenteritis in the preceding two years served as normal controls ( NOR-CON ) .  IL-1β and IL-1ra gene expressions were assayed by reverse transcriptase-polymerase chain reaction , and their levels of expression were quantitated by optical densitometry after electrophoresis on agarose gel . Results : INF-IBS patients exhibited significantly greater expression of IL-1β mRNA in rectal biopsies than INF-CON patients both during and three months after acute gastroenteritis . Moreover , IL-1β mRNA expression had increased in biopsies taken from INF-IBS patients at three months after the acute infection but no consistent change was observed in INF-CON patients . IL-1β mRNA expression of INF-IBS patients at three months post gastroenteritis was significantly greater than NOR-CON whereas that of INF-CON patients was not significantly different from NOR-CON . Despite these differential changes in IL-1β mRNA expression , no significant changes were observed in IL-1ra mRNA expression among the three groups . Conclusions : These findings indicate that those patients who develop IBS post infection exhibit greater IL-1β mRNA expression , both during and after the infection , compared with individuals who do not develop PI-IBS . We conclude that such patients may be susceptible to inflammatory stimuli , and that inflammation may play a role in the pathogenesis of PI-IBS Anti-depressants have been reported to be useful in the management of the  Irritable Bowel syndrome .  We studied the efficacy of amitriptyline for 12 weeks in a r and omized double-blind placebo-controlled trial . Forty patients who met predefined criteria entered the trial . They received 25 mg amitriptyline for the first week , 50 mg for the second week and 75 mg nightly thereafter until the end of the 12th week . The drug and placebo groups were comparable in all major pretreatment variables . Amitriptyline was found to be significantly more effective than placebo in producing global improvement , increasing feelings of well-being , reducing abdominal pain and increasing satisfaction with bowel movements . Younger age and increasing extroversion predicted a better response to amitriptyline .  Severity of depressive and anxiety symptoms and other personality variables did not influence outcome Involvement of pathogenic or potentially pathogenic bacteria in the pathogenesis of inflammatory bowel disease has long been suggested because , among other reasons , the inflammatory response resembles that in infectious bowel diseases . Elevated antibody levels to pathogen antigens and a changed metabolic activity of the intestinal microflora have been detected in patients with Crohn 's disease . Several studies have revealed a possible etiologic link between intestinal microorganisms and inflammatory bowel disease . Therefore , several therapeutic strategies , including reduction or dilution of bacterial components in the intestine by antibiotics or intestinal lavage , respectively , inactivation of inflammatory bacterial products , and reconstitution of intestinal microflora have been employed , substantiating the idea that dysfunction of the intestinal mucosal barrier and an alteration of bacterial composition contribute to the inflammatory disease . However , the beneficial effect of restoration of the physiologic intestinal microflora in colonic inflammation by exogenous administration of a viable nonpathogenic bacterium has not been investigated before in a placebo-controlled study . Promising results came from the present pilot study in which the nonpathogenic Escherichia coli strain Nissle 1917 was tested for efficacy and tolerance in maintaining remission in patients 
    Output:
    
: B. infantis 35624 has shown efficacy for improvement of IBS symptoms .