***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 . Germinated barley foodstuff ( GBF ) is a prebiotic foodstuff that effectively increases luminal butyrate production by stimulating the growth of protective bacteria . In the first pilot study , GBF has been shown to reduce both clinical activity and mucosal inflammation in ulcerative colitis ( UC ) . The aim of this study was to investigate the efficacy of GBF in the treatment of UC in a multicenter open control trial . Methods . Eighteen patients with mildly to moderately active UC were divided into two groups using a r and om allocation protocol . The control group ( n = 7 ) were given a baseline anti-inflammatory therapy for 4 weeks . In the GBF-treated group ( n = 11 ) , patients received 20–30 g GBF daily , together with the baseline treatment , for 4 weeks . The response to the treatments was evaluated clinical ly and endoscopically . Fecal micro-flora were also analyzed . Results . After 4 weeks of observation , the GBF-treated group showed a significant decrease in clinical activity index scores compared with the control group ( P < 0.05 ) . No side effects related to GBF were observed . GBF therapy increased fecal concentrations of Bifidobacterium and Eubacterium limosum . Conclusions . Oral GBF therapy may have the potency to reduce clinical activity of UC . We believe that these results support the use of GBF administration as a new adjunct therapy for UC This document represents the first collaboration between 2 organizations — the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine — to describe best practice s in nutrition therapy in critically ill children . The target of these guidelines is intended to be the pediatric critically ill patient ( > 1 month and 2–3 days in a PICU admitting medical , surgical , and cardiac patients . In total , 2032 citations were scanned for relevance . The PubMed / MEDLINE search result ed in 960 citations for clinical trials and 925 citations for cohort studies . The EMBASE search for clinical trials culled 1661 citations . In total , the search for clinical trials yielded 1107 citations , whereas the cohort search yielded 925 . After careful review , 16 r and omized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline . We used the GRADE criteria ( Grading of Recommendations , Assessment , Objective To determine the effectiveness of increasing the dietary content of soluble fibre ( psyllium ) or insoluble fibre ( bran ) in patients with irritable bowel syndrome . Design R and omised controlled trial . Setting General practice . Participants 275 patients aged 18 - 65 years with irritable bowel syndrome . Interventions 12 weeks of treatment with 10 g psyllium ( n=85 ) , 10 g bran ( n=97 ) , or 10 g placebo ( rice flour ) ( n=93 ) . Main outcome measures The primary end point was adequate symptom relief during at least two weeks in the previous month , analysed after one , two , and three months of treatment to assess both short term and sustained effectiveness . Secondary end points included irritable bowel syndrome symptom severity score , severity of abdominal pain , and irritable bowel syndrome quality of life scale . Results The proportion of responders was significantly greater in the psyllium group than in the placebo group during the first month ( 57 % v 35 % ; relative risk 1.60 , 95 % confidence interval 1.13 to 2.26 ) and the second month of treatment ( 59 % v 41 % ; 1.44 , 1.02 to 2.06 ) . Bran was more effective than placebo during the third month of treatment only ( 57 % v 32 % ; 1.70 , 1.12 to 2.57 ) , but this was not statistically significant in the worst case analysis ( 1.45 , 0.97 to 2.16 ) . After three months of treatment , symptom severity in the psyllium group was reduced by 90 points , compared with 49 points in the placebo group ( P=0.03 ) and 58 points in the bran group ( P=0.61 versus placebo ) . No differences were found with respect to quality of life . Fifty four ( 64 % ) of the patients allocated to psyllium , 54 ( 56 % ) in the bran group , and 56 ( 60 % ) in the placebo group completed the three month treatment period . Early dropout was most common in the bran group ; the main reason was that the symptoms of irritable bowel syndrome worsened . Conclusions Psyllium offers benefits in patients with irritable bowel syndrome in primary care . Trial registration Clinical trials NCT00189033 Background and Aim Partially hydrolyzed guar gum ( PHGG ) is a water-soluble , non-gelling dietary fiber with a wide range of uses in clinical nutrition . The aim of this prospect i ve study was to investigate the effect of guar gum on colonic transit time ( CTT ) and symptoms of chronic constipation . Methods We enrolled patients fulfilling Rome III criteria for chronic constipation . CTT was measured before and at the end of treatment . After a 2-week run-in period , patients received 5 mg PHGG daily for 4 weeks . During study period , patients kept daily symptoms , stool and laxative usage diaries . They also recorded their symptom-related satisfaction weekly and treatment adverse events . Results Forty-nine patients received treatment ; 39 ( 80 % ) completed the study . Treatment significantly reduced colon transit time , from 57.28 ± 39.25 to 45.63 ± 37.27 h ( p = 0.026 ) , a reduction more prominent in slow transit patients ( from 85.50 ± 27.75 to 63.65 ± 38.11 h , p = 0.016 ) . Overall , the weekly number of complete spontaneous and spontaneous bowel movements increased significantly ( p < 0.001 ) ; the latter correlated significantly with the acceleration of CTT in the overall population and in slow transit patients ( B = 0.382 ; p = 0.016 and B = 0.483 ; p = 0.023 , respectively ) . In addition , the number of bowel movements with straining decreased ( p < 0.001 ) and stool form improved ( p < 0.001 ) , while days with laxative intake and days with abdominal pain decreased ( p = 0.001 and p = 0.027 , respectively ) . Conclusion Four-week PHGG use accelerates colon transit time in patients with chronic constipation , especially in those with slow transit , and improves many of their symptoms including frequency of bowel movements BACKGROUND AND AIMS Enteral fiber-free diets alter intestinal transit and produce diarrhea or constipation . This prospect i ve double blind , controlled study evaluates the use of guar gum , a soluble fiber and a c and i date prebiotic in enteral feeds , to prevent diarrhea and potential health benefits in intensive care unit patients . METHODS Twenty patients on enteral nutrition with persistent diarrhea were r and omized to receive a new enteral feed either enriched with 2 % soluble guar gum ( study group , n = 10 ) or fiber-free ( control group , n = 10 ) for 4 successive days . RESULTS The number of liquid stools in response to a soluble fiber-enriched diet was 2.0+/-0.9 ( first day ) vs. 1.0+/-0.7 ( fourth day ) ( P < 0.01 ) , and in the control group 1.2+/-0.7 ( first day ) vs. 2.1+/-0.8 ( fourth day ) ( P < 0.05 ) . In the fiber-enriched feed group , plasma glucose and cholesterol levels at termination of the study , respectively , reached 126+/-81 and 164+/-71 mg dl(-1 ) , as compared to 333+/-108 and 378+/-26 mg dl(-1 ) on Day first ( P < 0.01 ) . In the control group , these values on the fourth day were , respectively , 267+/-94 and 263+/-79 vs. 247+/-115 and 315+/-78 on Day first ( P > 0.05 ) . CONCLUSIONS Guar gum-enriched enteral nutrition was related to a decrease of diarrheal episodes in ICU patients with preexisting diarrhea ; and to a trend for lower plasma glucose and cholesterol levels Abstract PURPOSE : Inflammation is a constant finding in the ileal reservoir of patients with an ileal pouch-anal anastomosis and is associated with decreased fecal concentrations of the short chain fatty acid butyrate , increased fecal pH , changes in fecal flora , and increased concentrations of secondary bile acids . In healthy subjects , inulin , a dietary fiber , is fermented to short chain fatty acids and leads to a lower pH and potentially beneficial changes in fecal flora . The aim of the present study was to investigate the effect of enteral supplementation of inulin on inflammation of the ileal reservoir . METHODS : Twenty patients received 24 g of inulin or placebo daily during three weeks in a r and omized , double-blind , crossover design . Stools were analyzed after each test period for pH , short chain fatty acids , microflora , and bile acids . Inflammation was assessed endoscopically , histologically , and clinical ly . RESULTS : Compared with placebo , three weeks of dietary supplementation with 24 g of inulin increased butyrate concentrations , lowered pH , decreased numbers of Bacteroides fragilis , and diminished concentrations of secondary bile acids in feces . This was endoscopically and histologically accompanied by a reduction of inflammation of the mucosa of the ileal reservoir . CONCLUSION : Enteral inulin supplementation leads to a decrease of inflammation-associated factors and to a reduction of inflammation of pouch mucosa The effect of hydrolyzed partially guar-gum was evaluated in the treatment of functional constipation among hospitalized patients . Following a r and omized blind controlled-trial 64 adults were allocated to two groups : one received daily high-fiber diet ( approximately 30 g ) and the other similar diet plus 10 g of hydrolyzed partially guar-gum , during 15 days . Dietary fiber reduced functional constipation by 78.0 % . Hydrolyzed partially guar-gum did not show any additional effect in defecation frequency , fecal consistence , need of laxative drug use , although a reduction in bowel complaints .  Dietary fiber may be used in the treatment of functional constipation . However the therapeutic role of hydrolyzed partially guar-gum should be further investigated BACKGROUND AND AIMS Attempts to control enteral nutrition associated diarrhea in the critically ill tube-fed patient by implementing feeding formulas enriched with fiber were mostly unsuccessful . Recently , it was shown that enteral feeding containing soluble partially hydrolyzed guar decreased the incidence of diarrhea in a cohort of non-critically ill medicosurgical patients . We investigated whether this type of enteral feed could also influence stool production in patients with severe sepsis , a population at risk for developing diarrhea . METHODS The study was double-blind . Patients with severe sepsis and septic shock were consecutively enrolled and at r and om received either an enteral formula supplemented with 22 g/l partially hydrolyzed guar or an isocaloric isonitrogenous control feed without fiber .  All patients were mechanically ventilated and treated with catecholamines and antibiotics . Enteral feeding was provided through a nasogastric tube for a minimum of 6 days . A semiquantitative score based on stool volume and consistency was used for daily assessment of diarrhea . RESULTS 25 patients fulfilled the criteria for data analysis . Soluble fiber was administered in 13 of them . The two groups were well-matched for gender , age , disease severity , cause of sepsis , laboratory parameters , total feeding days and time to reach nutritional goals . The mean frequency of diarrhea days was significantly lower in patients receiving fiber  than in those on st and ard alimentation ( 8.8+/-10.0 % vs 32.0+/-15.3 % ; P=0.001 ) . The whole group of fiber-fed patients had less days with diarrhea per total feeding days ( 16/148 days ( 10.8 % ) vs 46/146 days ( 31.5 % ) ; P<0.001 ) and a lower mean diarrhea score ( 4.8+/-6.4 vs 9.4+/-10.2 ; P<0.001 ) . The type of enteral diet did not influence sepsis-related mortality and duration of stay in the intensive care unit . CONCLUSION Total enteral nutrition supplemented with soluble fiber is beneficial in reducing the incidence of diarrhea in tube-fed full-resuscitated and mechanically ventilated septic patients OBJECTIVE Butyrate enemas may be effective in the treatment of active distal ulcerative colitis . Because colonic fermentation of Plantago ovata seeds ( dietary fiber ) yields butyrate , the aim of this study was to 
    Output:
    
Conclusions : GGPH is useful in the management of enteral nutrition associated diarrhea .