***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: Twelve ileostomy patients were given subcutaneous SMS 201 - 995 therapy ( 100 μg t.d.s . for 5 days ) in a r and omized placebo-controlled trial . All patients had ileostomies constructed 60 cm proximal to the terminal ileum ( proximal ileostomy ) following restorative proctocolectomy .  SMS 201 - 995 reduced the daily ileostomy output from 997±52 g to 736±28 g , P<0.05 , along with a decrease in daily sodium and chloride excretion ( sodium : 92.60±8.51 to 75.22±8.64 mEq , chloride : 143.46±8.54 to 113.60±15.84 mEq ; both P<0.05 ) . There were no significant changes in the plasma levels of glucagon , C peptide , insulin , renin or aldosterone with SMS 201 - 995 therapy . Patients developed no severe side effects and reported easier management of the ileostomy and a reduction in thirst . Our results suggest a possible clinical role for SMS 201 - 995 in the management of proximal ileostomy . Résumé12 patients avec iléostomie ont reçu une injection sous cutanée de SMS 201 - 995 ( 100 μg t.d.s . pour 5 jours ) au cours d'une étude r and omisée contre placebo . Tous ces patients avaient une iléostomie réalisée à 60 centimètres de la fin de l'iléon ( iléostomie proximale ) après proctocolectomie restaurative . Le SMS 201 - 995 diminuait le débit journalier de l'iléostomie de 997±52 g à 736±28 g , P<0.05 allant de pair avec une diminution de l'excrétion de sodium et de chlore ( sodium : 92.60±8.51 à 75.22±8.64 mEq , chlore : 143.46±8.54 à 113.60±15.84 mEq , tous les deux P<0.05 ) . Il n'y avait pas de variations significatives des taux plasmatiques de glucagon , peptide-C , insuline , renine , et aldostérone au cours du traitement par SMS 201 - 995 . Les malades n'ont pas developpé d'autres effets sévères et rapportaient un entretien plus facile de leur iléostomie et une réduction de la soif . Nos résultats suggèrent un possible rôle clinique pour SMS 201 - 995 dans le management d'une iléostomie proximale Somatostatin and octreotide both enhance closure of gastrointestinal fistulas .  The present trial was undertaken to test whether early combined treatment with parenteral nutrition and octreotide 100 μg every 8 h by subcutaneous injection had a beneficial effect compared with parenteral nutrition plus placebo . Thirty‐one patients with postoperative gastrointestinal or pancreatic fistula were r and omly assigned to receive parenteral nutrition plus octreotide ( 14 patients ) or placebo ( 17 ) within 8 days of fistula onset . The percentage reduction in output and rate of spontaneous closure within 20 days were analysed . Mean(s.d . ) reduction in output was similar after octreotide and placebo at 24 h ( 66(43 ) versus 68(47 ) per cent , P = 0.9 ) , 48 h ( 60(46 ) versus 57(43 ) per cent , P = 0.8 ) and 72 h ( 62(50 ) versus 66(49 ) per cent , P = 0.9 ) after starting the combined treatment . Closure within 20 days was observed in eight of 14 fistulas in patients given octreotide and in six of 17 in those receiving placebo ( P = 0.4 ) . Administration of octreotide , within 8 days of fistula onset , associated with parenteral nutrition does not significantly increase the spontaneous fistula closure rate compared with parenteral nutrition plus placebo Introduction An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities . Some studies have identified this as a precursor of dehydration and renal dysfunction . A prospect i ve study was performed of the complications associated with high-output stomas , to identify their causes , consequences and management . Material s and methods This study was carried out by a multidisciplinary team of surgeons , gastroenterologists , nutritionists and hospital pharmacists . High-output stoma ( HOS ) was defined as output ≥1500 ml for two consecutive days . The subjects included in the study population , 43 patients with a new permanent or temporary stoma , were classified according to the time of HOS onset as early HOS ( <3 weeks after initial surgery ) or late HOS ( ≥3 weeks after surgery ) . Circumstances permitting , a specific protocol for response to HOS was applied . Each patient was followed up until the fourth month after surgery . Results Early HOS was observed in 7 ( 16 % ) of the sample population of 43 hospital patients , and late HOS , in 6 of the 37 ( 16 % ) non-early HOS population .  By type of stoma , nearly all HOS cases affected ileostomy , rather than colostomy , patients . The patients with early HOS remained in hospital for 18 days post surgery , significantly longer than those with no HOS ( 12 days ) . The protocol was applied to the majority of EHOS patients and achieved 100 % effectiveness . 50 % of readmissions were due to altered electrolyte balance . Hypomagnesaemia was observed in 33 % of the late HOS patients . Conclusion The protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration BACKGROUND / AIMS Survival of patients with gastrointestinal cancer has improved recently with various multidisciplinary treatments . However , complications associated with the latter also increased , leading to impairment of quality of life and functional disability in patients .  Short bowel syndrome , characterized by severe watery diarrhea and electrolyte losses , is one of the major problems caused by gastrointestinal cancer and subsequent treatments . We investigated whether cimetidine , a gastric antisecretory agent , would ameliorate short bowel syndrome in patients after massive small bowel resection . METHODOLOGY The study design was such that the evaluation of cimetidine effects was an intra-patient comparison . The r and omized block method was used for statistical analyses of frequency and amount of daily watery fluid excretion and urine output , electrolyte levels in fluid secretions , as well as blood biochemistry , body weight and performance status . RESULTS Cimetidine administered at an early stage after bowel surgery , especially while patients are receiving parenteral nutrition , significantly decreased stool fluid excretion ( p=0.0001 ) , urine output ( p=0.0010 ) and electrolyte loss , which was no longer apparent a week after initiation of oral intake . CONCLUSIONS Cimetidine appears to be beneficial for cancer patients who have had extensive small bowel resection The quantitative effects of the antidiarrheal drug loperamide ( Imodium ® ) on several parameters of fecal composition and output were assessed in 7 patients with an ileorectal anastomosis and 7 patients with an ileostomy .  Loperamide ( two 2 mg capsules tid ) or placebo were administered double-blind in two r and omly assigned successive 7-day periods . Loperamide significantly decreased the daily volume , wet weight , water content , and fecal excretion rate and significantly increased the bulk density and viscosity of the fecal collection s. Electrolyte loss was significantly diminished with loperamide : Daily sodium and chloride outputs significantly decreased ; daily calcium , phosphate and potassium outputs slightly decreased . Sodium concentration significantly decreased , while potassium and calcium concentrations significantly increased , phosphate concentrations slightly increased , and chloride concentrations slightly decreased . The sodium/potassium ratio was significantly reduced . No effect on fecal dry weight or on lipid or bile acid outputs was observed . Differences in fecal composition between patients with an ileorectal anastomosis and those with an ileostomy were identified . Potassium concentration and output were significantly higher , and the sodium/potassium ratio was significantly lower in patients with an ileorectal anastomosis . This group also showed a tendency to slightly lower fecal volume , wet weight , water content , fecal excretion rate , sodium concentration , and output . A patient per patient evaluation of clinical responsiveness to loperamide was made by comparing several fecal variables before and after loperamide treatment . The therapeutic efficacy of loperamide was comparable in both patient groups . Results were rated “ excellent ” in 3 patients , “ good ” in 7 , “ question able ” in 3 and “ poor ” in 1 . No adverse effects attributable to loperamide were observed . All patients reported feeling better during loperamide treatment and preferred the active drug period to the placebo period The effect of the H2-receptor blocking agent cimetidine on jejunal effluent was examined in eight short-bowel patients with high-output jejunostomies .  Stool mass and faecal excretion of sodium and potassium were significantly reduced by intravenous injection of 400 mg cimetidine four times a day . The amount of calcium , magnesium , phosphate , zinc , and fat in jejunostomy effluent did not change significantly . Cimetidine may be considered an antidiarrhoeal drug in extensively small-bowel-resected patients with a jejunostomy and may reduce the need for parenteral saline supply in these patients Loperamide hydrochloride ( 4 mg t.d.s . ) was compared with codeine phosphate ( 60 mg t.d.s . ) in a double blind crossover study of patients with loose output from their ileostomies . Both drugs significantly decreased the daily output and water content of ileostomy fluid . Daily losses of sodium and potassium were less when the patients were treated with loperamide . Loperamide was also associated with less side effects . It is concluded that loperamide hydrochloride was more effective in the treatment of ileostomy diarrhoea than codeine phosphate . In this group of patients those with the highest outputs from their ileostomies benefited most from this treatment The effect of an H2-receptor blocking agent , cimetidine , on faecal losses of fluid , electrolytes and fat was examined in 10 patients with Crohn 's disease , who had diarrhoeas after extensive small bowel resection . A r and omized , double-blind and cross-over design was applied , and patients were hospitalized and on a defined diet during the study . Cimetidine , 4 x 400 mg , significantly reduced diarrhoeal volumes by an average of 22 % ( p less than 0.05 ) and faecal sodium by 27 % ( p less than 0.05 ) . Patients with severe diarrhoeas responded better to treatment . No side-effects were recorded . The reported data suggest that cimetidine may be useful in symptomatic treatment of patients with severe diarrhoeas  after extensive ileal resection . Due to deficient drug absorption , higher doses may be needed for optimal effect Objective : Continuous intravenous infusion of somatostatin improves the natural course of digestive fistulae .  Lanreotide 30 mg PR is a synthetic analogue of somatostatin with pharmacological activity extending to at least 10 days after intramuscular administration . Its effectiveness was assessed in patients with simple externalized digestive fistulae in a r and omized , double-blind , placebo-controlled study . Methods : Patients demonstrating a reduction of at least 50 % of fistula output within 72 hours after a first double-blind intramuscular injection of lanreotide or placebo  were considered to be responders ( primary end point ) and continued the double-blind treatment to a maximum of 6 injections at 10-day intervals . Other endpoints included fistula closure rate and time to closure . Blind was lifted for nonresponders , and those initially on placebo were then treated with open-label lanreotide . Results : Following the first double-blind injection , 35 of 54 patients ( 64.8 % ) on lanreotide were responders versus 20 of 53 ( 37.7 % ) on placebo , ie , a 3.1 times higher response likelihood on lanreotide compared with placebo ( P = 0.006 ) . Group mean reduction of fistula output at 72 hours was 45.1 % and 8.9 % , respectively ( P = 0.005 ) . Lanreotide compared with placebo had no effect on closure rate which averaged 77 % but median time to fistula closure was shorter on lanreotide , based on Kaplan-Meier analysis , although no statistical significance was achieved . Conclusion : Compared with placebo , intramuscular lanreotide 30 mg PR significantly decreases digestive fistulae output at Day 3 and shortens time to fistula closure by 9 days . Clinical Trials.gov registration number : NCT00729313 To evaluate the effectiveness of treatment with total parenteral nutrition ( TPN ) alone ( group A ) or combined with continuous intravenous infusion of somatostatin ( group B ) in postoperative gastrointestinal fistulas , a multicenter , controlled and prospect i ve r 
    Output:
    
On the basis of these outcomes and clinical experience , we proposed an algorithm for st and ard of care which consists of high-dose proton pump inhibitors combined with high-dose loperamide as the first step followed by addition of codeine in case of insufficient output reduction .
So far , there is insufficient evidence for the st and ard use of somatostatin ( analogues ) .