***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: The effect of open treatment with coarse wheat bran was compared with response to placebo , given in the form of a double blind , cross over drug trial , in patients with irritable bowel syndrome . Both bran and placebo significantly reduced the severity of most of the symptoms . Constipation was the only symptom that improved significantly with bran , but not with placebo , and was the only symptom that predicted a successful outcome with bran .  Diarrhoea did not improve with bran . In fact , stools became less formed in patients presenting with this symptom . The incidence of pain and urgency was significantly more frequent on bran compared with placebo . Compared with a baseline period , bran treatment result ed in an acceleration of whole gut transit time ( p less than 0.05 ) increases in daily stool weight ( p less than 0.01 ) and the proportion of unformed stools ( p less than 0.01 ) but no change in stool frequency .  Coarse wheat bran was no better than placebo for most symptoms in irritable bowel syndrome , although its efficacy in constipation was confirmed 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 The aims of this study were to determine ( a ) whether dietary fiber supplements modify symptoms in patients with irritable bowel syndrome , ( b ) the effect of fiber on rectosigmoid pressures , and ( c ) the relationship , if any , between rectosigmoid pressure and symptoms . Fourteen patients entered and 9 completed a double-blind , controlled , cross-over study of 7 mo duration . The mean age was 26 yr ( range , 18 - 37 ) . Patients received 4 cookies daily containing 20 mg corn fiber or placebo . Symptoms and compliance were evaluated monthly . Rectosigmoid pressures and dietary intake were evaluated at the outset and completion of each study arm . Symptoms improved during both fiber and placebo treatments . Those symptoms demonstrating significant improvement with time were pain severity , stool frequency , stool consistency ( p = 0.001 ) , number of additional gastrointestinal symptoms present ( p = 0.02 ) , and total symptom score ( p less than 0.001 ) . Rectosigmoid pressures were not significantly altered by fiber or placebo .  Fasting pressures at the distal recording site tended to correlate with pain severity ( r = 0.6 ; p = 0.06 ) . It was concluded that ( a ) corn fiber and placebo were both effective in alleviating symptoms , ( b ) there was a correlation between symptom severity and fasting rectosigmoid pressure , and ( c ) there was a trend toward reduction in fasting and postpr and ial rectosigmoid pressures after fiber therapy A double-blind controlled therapeutic trial of factorial design was used to study the therapeutic effects of lorazepam , hyoscine butylbromide , and ispaghula husk in 12 r and omised blocks of eight patients with the irritable bowel syndrome ( IBS ) . Each of the three agents caused a sustained symptomatic improvement in some of the patients , although only with ispaghula was the difference between the real and dummy preparation statistically significant . When the eight possible combinations of treatment were analysed none of the 12 patients who received only dummy preparations of the three agents had maintained any improvement over the three months of the trial . Seven patients improved among the 12 who received potent preparations of all three agents , and between four and six patients improved in the groups receiving one or two of the potent preparations . These therapeutic results , though far from perfect , show that the types of drug commonly used to treat IBS are of some value and may be additive in their effects . Similar combinations of other therapeutic agents may be more effective , but it will be possible to determine this only by carrying out factorial therapeutic trials This placebo controlled , double-blind , cross-over trial involving 20 patients was conducted to assess the effect of ispaghula husk on the major bowel symptoms and the whole gut transit time in irritable bowel syndrome ( IBS ) and to determine if changes in these parameters were related to global improvement . All 20 patients were interviewed at the end of the treatment periods and 14 patients kept concurrent daily records . Ispaghula therapy result ed in improvement in global symptoms and satisfying bowel movements ( P less than 0.001 ) but produced no change in abdominal pain or flatulence . There was a correlation between the improvement of well-being and the number of days of satisfying bowel movements ( P less than 0.001 ) but not with the indexes of pain , stool frequency or changes in the transit time . The easing of bowel dissatisfaction appears to be a major reason for the therapeutic success of ispaghula in IBS 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 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 We studied 114 patients affected by irritable bowel syndrome ( IBS ) ( group A = 53 patients , group B = 61 ) . Group A received diet with high content of roughage ( 20 g of fibers ) and 10 g of bran , group B received otilonium bromide ( OB ) 40 mg tid and normal diet ( 10 - 15 g of fibers ) . Abdominal pain , abdominal distension , bowel movements were evaluated before treatment ( T0 ) at the end ( T24 ) and after 12 months ( T12 ) . In group B otilonium bromide induced a significant improvement ( p less than 0.01 ) of abdominal pain and distension when comparing T0 with T24 . In group A diet produced an improvement , albeit not significant , of the aforementioned parameters at T24 . On the basis of our data OB seems to be more effective than a high-fiber diet in the treatment of IBS Background Many patients with IBS suffer on-going symptoms . The evidence base is poor for IBS drugs but they are widely prescribed and advised in Guidelines . Cognitive Behavioural Therapy ( CBT ) can be helpful , but availability is poor in the NHS . We developed a web-based CBT self-management programme ( Regul8 ) in partnership with patients and trialled it and common IBS medications in an exploratory factorial RCT to test trial procedures and provide information for a larger trial . Methods Patients , 16 to 60 years , with IBS symptoms fulfilling Rome III criteria were recruited via GP practice s and r and omised to over-encapsulated mebeverine , methylcellulose or placebo for 6 weeks and to 1 of 3 website conditions : Regul8 with a nurse telephone session and email support , Regul8 with minimal email support , or no website . Results 135 patients recruited from 26 GP practice s.  Mean IBS SSS score 241.9 ( sd 87.7 ) , IBS-QOL 64 ( sd 20 ) at baseline . 91 % follow-up at 12 weeks . Mean IBS SSS decreased by 35 points from baseline to 12 weeks . There was no significant difference in IBS SSS or IBS-QOL score between medication or website groups at 12 weeks , or in medication groups at 6 weeks , or IBS-QOL in website groups at 6 weeks . However , IBS SSS at 6 weeks was lower in the No website group than the website groups ( IBS SSS no website = 162.8 ( 95 % CI 137.4 - 188.3 ) , website 197.0 ( 172.4 - 221.7 ) , Website + telephone support 208.0 ( 183.1 - 233.0 ) p = 0.037).Enablement and Subjects Global Assessment of relief ( SGA ) were significantly improved in the Regul8 groups compared to the non-website group at 12 weeks ( Enablement = 0 in 56.8 % of No website group , 18.4 % website , 10.5 % Website + support , p = 0.001 ) ( SGA ; 32.4 % responders in No website group , 45.7 % website group , 63.2 % website + support group , p = 0.035 ) . Conclusions This exploratory study demonstrates feasibility and high follow-up rates and provides information for a larger trial . Primary outcomes ( IBS SS and IBS QOL ) did not reach significance at 6 or 12 weeks , apart from IBS SSS being lower in the no-website group at 6 weeks - this disappeared by 12 weeks . Improved Enablement suggests patients with access to the Regul8 website felt better able to cope with their symptoms than the non-website group . Improved SGA score in the Regul8 groups may indicate some overall improvement not captured on other measures .Trial registration Clinical Trials.gov Identifier ( NCT number ) : NCT00934973 BACKGROUND Manipulation of dietary fibre intake represents a longst and ing treatment for patients with irritable bowel syndrome ( IBS ) , particularly for those with constipation .  Linseeds are often recommended by both clinicians and dietitians as a source of dietary fibre to alleviate symptoms . Recent guidance on the management of irritable bowel syndrome ( IBS ) advises that linseeds may reduce wind and bloating , although there is limited clinical evidence to support this recommendation . The present pilot study aim ed to compare the clinical effectiveness of : ( i ) whole linseeds versus ground linseeds ; ( ii ) whole linseeds versus no linseeds ; and ( iii ) ground linseeds versus no linseeds in the management of IBS symptoms . METHODS In an open r and omised controlled trial , subjects with IBS ( n = 40 ) were allocated to one of three intervention groups : two tablespoons of whole linseeds per day ( n = 14 ) , two tablespoons of ground linseeds per day ( n = 13 ) and no linseeds as controls ( n = 13 ) . Symptom severity ( primary outcome ) and bowel habit were assessed before and after a 4-week intervention and statistical differences between the groups were compared . RESULTS Thirty-one subjects completed the present study . Between-group analysis comparing the improvement in symptom severity did not reach statistical significance for whole linseeds ( n = 11 ) versus ground linseeds ( n = 11 ; P = 0.62 ) , whole linseeds versus controls ( n = 9 ; P = 0.12 ) and ground linseeds versus controls ( P = 0.10 ) . There were no significant changes in stool frequency or stool consistency for any of the groups . CONCLUSIONS Linseeds may be useful in relief of IBS symptoms . Further research is needed to detect clear differences between the effects of whole and ground linseeds Twenty eight patients with classical irritable bowel syndrome completed a double blind placebo controlled crossover trial in which they added to their normal diet a daily supplement of either 12 bran biscuits ( 1 = 1.3 g fibre ) or 12 placebo biscuits ( 1 = 0.23 g fibre ) . Each biscuit was given for three months in r and om order with crossover to the alternative biscuit at three months . After the initial three months therapy , there was a 
    Output:
    
Soluble fiber appears to improve symptoms of IBS , whereas there is no evidence for recommending insoluble fiber for IBS