***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: After a two-week basal period , 24 patients were r and omly allocated to receive , with a crossover double-blind design , for two consecutive four-week periods , bran ( 20 g/24 hr ) or placebo . The daily intake of water and dietary fibers was st and ardized . Symptomatology , oroanal transit time , bowel frequency , and stool weight were assessed in basal conditions and at week 4 and 8 of the treatment . Oroanal transit time decreased and bowel frequency and stool weight increased significantly during both bran and placebo administration in comparison with basal period . Bran treatment was more effective than placebo in improving bowel frequency and oroanal transit . During bran treatment oroanal transit time became normal only in patients with slow colonic transit and not in those with slow rectal transit . Neither the occurrence nor the severity of the most frequent accompanying symptoms of chronic constipation differed significantly between placebo and bran treatments The aim of this study was to evaluate the effect of a novel laxative preparation , composed of cel and in , aloevera and psyllium in patients with chronic constipation . Thirty-five men and women were r and omized to receive capsules containing cel and in-aloevera-psyllium , or placebo , in a double-blind trial lasting 28 days . Symptoms in the last 2 weeks of the treatment period were compared to those in the 14-day pre-trial basal period . In the cel and in , aloevera and psyllium group , bowel movements became more frequent , the stools were softer and laxative dependence was reduced . In the placebo group , all these parameters were unchanged . Abdominal pain was not reduced in either group . The results of this study show that the preparation is an effective laxative in the treatment of constipation 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 : Psyllium is widely used in the symptomatic therapy of constipation . Its effects on colonic function and their correlation with symptomatic response have not been defined The digestibility of ispaghula , a mucilage from Plantago ovata composed mainly of arabinoxylans , and its faecal bulking effect were studied in seven healthy volunteers who ingested a low fibre controlled diet plus either placebo or 18 g/day of ispaghula for two 15 day periods .  Whole gut transit time and gas excretion in breath and flatus were not different during the periods of ispaghula and placebo ingestion . Faecal wet and dry weights rose significantly , however , during ispaghula ingestion . Faecal short chain fatty acid concentrations and the molar proportions of propionic and acetic acids also increased . Most of the ispaghula had reached the caecum four hours after ingestion in an intact highly polymerised form . During ispaghula ingestion , the increase in the faecal output of neutral sugars was accounted for by the faecal excretion of arabinose and xylose in an intact highly polymerised form ; the apparent digestibilities of these sugars were 24 ( 11 ) and 53 % ( 6 ) respectively ( mean ( SEM ) ) . In conclusion , ispaghula is more resistant to fermentation than previously reported in humans , and its bulking effect largely results from intact material In 18 students and two members of staff at a boys ' boarding school , the time taken to pass 20 out of 25 radiopaque pellets varied from one to seven days while the subjects were eating a normal English diet . After the additon of bran , about 20 g daily , to this diet transit time fell from 2 - 75 plus or minus 1 - 6 to 2 - 0 plus or minus 0 - 9 days ( P smaller than 0 - 025 ) . Transit became faster in all nine subjects who had an initial time of three days or more , and in three of seven with an initial time of two days , but became slower in all four boys with an initial one-day transit . Frequency of defaecation correlated poorly with transit time ( a once daily bowel action being found with transit times ranging from one to four days ) , and did not increase significantly with bran . In 10 additional adults with slow initial transit ( three or four days ) the effect of bran was compared with that of an equal volume of ground oatflakes in a double-blind crossover trial . Bran caused a significant acceleration of transit , wherease oatmeal had no effect . These studies confirm that bran accelerates slow intestinal transit and show that this is not simply a psychological effect . Bran may also slow down fast transit BACKGROUND Chronic constipation may result from many mechanisms including colonic inertia or rectosigmoid outlet delay , but risk factors for constipation in the community are poorly defined . The prevalence of and predictors for symptoms consistent with functional constipation and outlet delay were estimated . METHODS An age- and gender-stratified r and om sample of 1,021 residents of Olmsted County , MN , aged 30 - 64 years , was mailed a valid self-report question naire ; 835 responded ( 82 % ) . These respondents were mailed a second question naire 12 - 20 months later that gathered data on symptoms compatible with functional constipation and outlet delay ; 690 responded ( 83 % ) . RESULTS Self-reported constipation did not reliably identify functional constipation or outlet delay . The overall age- and gender-adjusted prevalences ( per 100 ) of functional constipation and outlet delay were 19.2 ( 95 % confidence interval [ CI ] , 16.1 - 22.3 ) and 11.0 ( 95 % CI , 8.7 - 13.3 ) , respectively . Outlet delay but not functional constipation was more frequent in women . After adjusting for age , gender , and other symptoms , an increased usage of aspirin was associated with functional constipation but not outlet delay . CONCLUSIONS In apparently healthy middle-aged persons , approximately 1 in 5 have symptoms compatible with functional constipation , and 1 in 10 may experience outlet delay , but these groups correspond poorly with self-reported constipation Objective : The aim of the study was to investigate the effects of fibre-rich rye bread and yoghurt containing Lactobacillus GG ( LGG ) on intestinal transit time and bowel function , and to test whether they have an interaction in cases of self-reported constipation . Design : The study was carried out as a two-by-two factorial design . Setting : Free-living subjects . Subjects : A total of 59 healthy women with self-reported constipation , recruited by advertisement . Interventions : After a baseline period , the subjects were r and omized into four diet groups : ( 1 ) rye bread+LGG yoghurt , ( 2 ) rye bread , ( 3 ) LGG yoghurt , and ( 4 ) control . The 3-week dietary intervention was followed by a 3-week follow-up period . During each period , total intestinal transit time was measured and the subjects recorded faecal frequency and consistency , difficulty in defecation and gastrointestinal symptoms . Results : The rye bread shortened total intestinal transit time ( mean difference , −0.7 ; CI95 , −1.1 to −0.2 ; P=0.007 ) , increased faecal frequency ( 0.3 ; CI95 , 0.1 to 0.5 ; P=0.001 ) , softened faeces ( −0.3 ; CI95 , −0.4 to −0.2 ; P<0.001 ) and made defecation easier ( −0.4 ; CI95 , −0.5 to −0.2 ; P<0.001 ) , but also increased gastrointestinal symptoms ( 1.6 ; CI95 , 0.7 to 2.4 ; P<0.001 ) compared to the low-fibre toast consumed in the LGG and control groups . There were fewer symptoms in the rye bread+LGG group compared to the rye bread group ( −1.3 ; CI95 , −2.4 to −0.2 ; P=0.027 ) . Conclusions : Fibre-rich rye bread can be recommended in the treatment of constipation , and the simultaneous consumption of LGG yoghurt relieves the adverse gastrointestinal effects associated with increased intake of fibre . Sponsorship : Valio Ltd , R&D , and Fazer Bakeries OBJECTIVES : Although it has been used as a laxative for many years , high- quality trials assessing the efficacy of the laxative sodium picosulfate ( SPS ) are lacking . The purpose of this study was to assess the efficacy and safety of 4-week treatment with SPS in patients with functional constipation as defined by the Rome III diagnostic criteria . METHODS : This study was a r and omized , double-blind , placebo-controlled , parallel-group study in 45 general practice s in Germany . A total of 468 patients with chronic constipation presenting to their general practitioner and fulfilling the Rome III diagnostic criteria were screened . After a 2-week baseline period , 367 patients were r and omized to either SPS drops or matching placebo in a 2:1 ratio for 4 weeks . Dose titration was permitted throughout treatment . Patients without a bowel movement for more than 72 h were allowed to use a “ rescue ” bisacodyl suppository . The primary end point was the mean number of complete spontaneous bowel movements ( CSBMs ) per week . A spontaneous bowel movement ( SBM ) was defined as a stool not induced by rescue medication , whereas a CSBM was defined as an SBM associated with a sensation of complete evacuation . RESULTS : The mean number ( ±s.e . ) of CSBMs per week increased from 0.9±0.1 to 3.4±0.2 in the SPS group and from 1.1±0.1 to 1.7±0.1 in the placebo group ( P<0.0001 ) . The percentage of patients reaching an increase of ≥1 in the mean number of CSBMs per week compared to baseline was 65.5 % vs. 32.3 % , respectively ( P<0.0001 ) . The percentage of patients reaching a mean number of at least three CSBMs per week was 51.1 % in the SPS group and 18.0 % in the placebo group ( P<0.0001 ) . After 24 h , approximately 69 % of patients in the SPS group and 53 % in the placebo group had their first SBM . The SPS dose was titrated down during the study by nearly 50 % of patients . Assessment of quality of life ( QoL ) by the constipation-related Patient Assessment of Constipation (PAC)-QoL question naire showed significant improvement in SPS-treated patients compared to the placebo group . CONCLUSIONS : Treatment of chronic constipation  with SPS  improves bowel function , symptoms , and QoL and is well tolerated . The dose can be adjusted individually while maintaining benefit Until recently many clinical trials of functional gastrointestinal disorders ( FGIDs ) suffered from important weaknesses in trial design , study execution , and data analysis . This makes it difficult to determine whether truly efficacious therapies exist for these disorders . One of the important method ologic problems is the absence of vali date d outcome measures and lack of consensus among stakeholders on how to measure outcome . Currently much of the effort is being put into the development of vali date d outcome measures for several of the FGIDs . The r and omized , controlled trial with parallel groups is the design of choice . In this 
    Output:
    
Evidence for any benefit of insoluble fibre was conflicting .
Soluble fibre may be of benefit in chronic idiopathic constipation , but data for insoluble fibre are conflicting .