***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 : Irritable bowel syndrome remains the commonest reason for referral to a gastroenterology clinic . Patients with irritable bowel syndrome are frequently advised to increase their intake of bran fibre , despite inconclusive experimental evidence of benefit CONTEXT Irritable bowel syndrome ( IBS ) is a common functional bowel disorder for which there is no reliable medical treatment . OBJECTIVE To determine whether Chinese herbal medicine ( CHM ) is of any benefit in the treatment of IBS . DESIGN R and omized , double-blind , placebo-controlled trial conducted during 1996 through 1997 . SETTING Patients were recruited through 2 teaching hospitals and 5 private practice s of gastroenterologists , and received CHM in 3 Chinese herbal clinics . PATIENTS A total of 116 patients who fulfilled the Rome criteria , an established st and ard for diagnosis of IBS . INTERVENTION Patients were r and omly allocated to 1 of 3 treatment groups : individualized Chinese herbal formulations ( n = 38 ) , a st and ard Chinese herbal formulation ( n = 43 ) , or placebo ( n = 35 ) . Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist . Patients , gastroenterologists , and herbalists were all blinded to treatment group . MAIN OUTCOME MEASURES Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients . RESULTS Compared with patients in the placebo group , patients in the active treatment groups ( st and ard and individualized CHM ) had significant improvement in bowel symptom scores as rated by patients ( P=.03 ) and by gastroenterologists ( P=.001 ) , and significant global improvement as rated by patients ( P=.007 ) and by gastroenterologists ( P=.002 ) . Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms ( P=.03 ) . Chinese herbal formulations individually tailored to the patient proved no more effective than st and ard CHM treatment . On follow-up 14 weeks after completion of treatment , only the individualized CHM treatment group maintained improvement . CONCLUSION Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS OBJECTIVES : Psychological treatments are considered to be useful in the irritable bowel syndrome ( IBS ) , although the evidence is based on small , often flawed trials . Although cognitive behavior therapy ( CBT ) and relaxation therapy have both been promising , we hypothesized that CBT would be superior to relaxation and st and ard care alone in IBS patients . The objective of this study was to test this assumption by comparing the effects of cognitive behavior therapy with relaxation therapy and routine clinical care alone in individuals with IBS . METHODS : Patients ( n = 105 ) with Rome I criteria for IBS were recruited from advertisement ( n = 51 ) and outpatient clinics ( n = 54 ) ; those patients with resistant IBS were not included . A r and omized controlled trial with three arms ( st and ard care for all groups plus either CBT or relaxation ) for 8 wk was conducted , which applied blinded outcome assessment s using vali date d measures with 1 yr of follow-up . The primary outcome for this study was bowel symptom severity . RESULTS : Of 105 patients at the commencement of treatment , the mean bowel symptom frequency score for the whole sample was 21.1 and at the end of treatment had fallen to 18.1 ; this persisted at the 52-wk follow-up , with a significant linear trend for scores to change over time ( F= 39.57 p < 0.001 ) . However , there were no significant differences among the three treatment conditions . Significant changes over time were found for physical functioning ( F= 4.37 , p < 0.001 ) , pain ( F= 3.12 , p < 0.05 ) , general health ( F= 2.71 , p < 0.05 ) , vitality ( F= 2.94 , p < 0.05 ) , and the social functioning scales on the Medical Outcomes Study Short Form 36 ( F= 4.08 , p < 0.05 ) ; however , all three arms showed similar improvement . There were significant reductions in anxiety , depression , and locus of control scales , but no significant differences among the treatment groups were detected . CONCLUSION : Cognitive behavior and relaxation therapy seem not to be superior to st and ard care alone in IBS Twenty-six patients with irritable bowel syndrome entered a controlled trial of diets with a high or low wheat-fibre content . After 6 weeks on the high-wheat fibre regimen there was significant improvement in symptoms and an objective change in colonic motor activity . No such improvement occurred on the low-fibre regimen .  Patients with irritable bowel syndrome should be encouraged to increase their daily intake of wheat fibre 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 AIM Irritable bowel syndrome ( IBS ) is a common disorder and many patients fail to find adequate relief from conventional therapies for their symptoms . This study tests the cl aim that acupuncture is effective for a majority of these patients . METHODS A prospect i ve , blinded , sham acupuncture-controlled trial of traditional Chinese acupuncture was performed at a single postgraduate teaching hospital in Europe . Sixty patients with well-established IBS were recruited . The blinded comparator was sham acupuncture administered by the second of two acupuncturists who alone was aware of the r and omization , and who otherwise followed the prescription of the first . The primary end-point was a defined fall in the symptom score at 13 wk ( by intention to treat ) . The prior expectation was a 30 % placebo response , and a response rate of 70 % from acupuncture , for which the study was adequately powered . RESULTS Patients in treated and sham groups improved significantly during the study -mean improvement in scores being equal ( minus 1.9 ) and significant for both ( P<0.05 ; one-tailed t test ) . There was a small numeric but non-significant difference between the response rate in patients receiving acupuncture ( 40.7 % ) and sham treatment ( 31.2 % ) . Several secondary end-points marginally favored active treatment , but an improved symptom score of any degree of magnitude occurred more often with sham therapy ( 65.6 % vs 59.2 % ) . For no criterion was statistical significance approached . CONCLUSION Traditional Chinese acupuncture is relatively ineffective in IBS in the European hospital setting , and the magnitude of any effect appears insufficient to warrant investment in acupuncture services BACKGROUND Abdominal pain/discomfort , bloating , and constipation are gastrointestinal dysmotility and sensory symptoms associated with irritable bowel syndrome ( IBS ) . No studies have followed patients with IBS symptoms for 1 year under conditions of routine clinical practice to assess prospect ively the impact of treatments on health outcomes . OBJECTIVE The objective of this ongoing , naturalistic study is to assess the long-term impact of IBS treatments on quality of life ( QOL ) , work productivity , and re source utilization . This report describes the baseline characteristics and patterns of care of the patients enrolled in this study . METHODS Patients with physician-diagnosed IBS symptoms were enrolled from 147 physician sites across Canada between May 4 , 2004 , and March 31 , 2005 . Clinical data were collected at baseline and at the end of the 12-month follow-up ( patients were followed for 1 year between May 4 , 2005 , and March 31 , 2006 ) . Patient-reported outcomes were collected at baseline and at months 1 , 2 , 6 , 9 , and 12 . Health-related QOL , health status , and work productivity were assessed with the IBS-QOL , a 5-item EuroQol descriptive system , and Work Productivity and Activity Impairment question naires , respectively . A re source utilization question naire elicited information on physician ; visits , treatments , and procedures . Baseline data are reported here . RESULTS Data were obtained from 1555 patients ; 85.1 % ( 1320/1552 ) were women . Patients had a mean ( SD ) age of 45.8 ( 15.0 ) years and mean ( SD ) duration of IBS symptoms of 11.4 ( 11.5 ) years . Self-reported bowel patterns were predominantly constipation ( 41.0 % , 587/1433 ) and constipation alternating with diarrhea ( 39.4 % , 564/1433 ) ; 60.3 % ( 938/1555 ) of subjects used > or =3 IBS treatments in the previous 4 weeks . Approximately 50 % of all patients reported distress " quite a bit or " extremely " for abdominal pain , gas , bloating , and constipation . The mean overall IBS-QOL score ( 0 - 100 scale , with 0 indicating poor QOL ) was 66.3 ; food avoidance ( 51.8 ) and health worry ( 59.3 ) were the most serious concerns . Patients reported 5.6 % work absenteeism , 31.4 % presenteeism , and 34.6 % overall work productivity loss , equivalent to 13.8 hours lost productivity per 40-hour workweek . CONCLUSIONS The baseline data from this ongoing , prospect i ve , naturalistic study are consistent with previous findings that suggested significant use of health care re sources with concomitant low QOL and decreased work productivity in patients with IBS symptoms BACKGROUND : As there is no effective treatment for irritable bowel syndrome ( IBS ) , many patients turn to traditional Chinese medicine ( TCM ) for possible cure . We investigated the therapeutic efficacy of an ancient herbal Chinese formula in patients with diarrhea-predominant IBS . METHODS : This was a r and omized double-blinded placebo-controlled trial . Chinese IBS patients with predominant diarrhea symptoms that fulfilled Rome II criteria were recruited . The diagnosis was verified by a TCM herbalist using TCM criteria . Eligible patients were r and omized to receive a st and ard preparation of TCM extracts that contained 11 herbs or placebo with similar appearance and taste for 8 wk after a 2-wk run-in period . Patients were followed up for an additional 8 wk post-treatment . Primary outcome was patient 's global symptom assessment . Other outcome measures included individual IBS symptom scores and health-related quality of life ( short form 36 ) . RESULTS : One hundred nineteen patients were r and omized : 60 to receive TCM and 59 to receive placebo . There was no significant difference in the proportion of patients with global symptom improvement between the TCM and placebo groups at week 8 ( 35 % vs 44.1 % , p = 0.38 ) and at week 16 ( 31.7 % vs 33.9 % , p = 0.62 ) . Moreover , there was no difference in individual symptom scores and the quality -of-life assessment between the two groups at all time points . BACKGROUND : The use of this herbal formulation for diarrhea-predominant IBS did not lead to global symptom improvement . Further controlled clinical studies may be necessary to characterize the role of TCM in the management of IBS 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 To determine the efficacy and tolerability of an enteric-coated peppermint-oil formulation ( Colpermin ) , we conducted a prospect i ve , r and omized , double-blind , placebo-controlled clinical study in 110 out patients ( 66 men/44 women ; 18–70 years of age ) with symptoms of irritable bowel syndrome . Patients took one capsule ( Colpermin or placebo ) three to four times daily , 15–30 min before meals , for 1 month . Fifty-two patients on  Colpermin and 49 on placebo completed the study . Forty-one patients on Colpermin ( 79 % ) experienced an alleviation of the severity of abdominal pain ( 29 were pain 
    Output:
    
MAIN MESSAGE Soluble fibre improves constipation and global IBS symptoms .
Peppermint oil alleviates IBS symptoms , including abdominal pain .
Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain .
Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients .
Certain herbal formulas are supported by limited evidence , but safety is a potential concern .
Several complementary and alternative therapies can be recommended as part of an evidence -based approach to the treatment of IBS ; these might provide patients with satisfactory relief and improve the therapeutic alliance