***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: OBJECTIVE The study aim ed to assess the effect of a symbiotic gel on presence and severity of gastrointestinal symptoms ( GIS ) in hemodialysis patients . DESIGN A double-blinded , placebo-controlled , r and omized , clinical trial was design ed . The study was conducted at 2 public hospitals in Guadalajara , Mexico . SUBJECTS AND INTERVENTION Twenty-two patients were r and omized to the intervention group ( nutritional counseling + symbiotic gel )  and 20 patients were r and omized to the control group ( nutritional counseling + placebo )  , during 2 months of follow-up . MAIN OUTCOME MEASURE Presence and monthly episodes of GIS were assessed by direct interview and severity by using the self-administered GIS question naire . Additionally , biochemical parameters , inflammatory markers , and nutritional status ( dietary intake , subjective global assessment , anthropometry , and body composition ) were evaluated . RESULTS After a 2-month treatment , intervention group had a significant reduction in prevalence and monthly episodes of vomit , heartburn , and stomachache , as well as a significant decrease in GIS severity compared with control group . Moreover , intervention group had a greater yet not significant decrease in the prevalence of malnutrition and a trend to reduce their C-reactive protein and tumor necrosis factor α levels compared with control group . No symbiotic-related adverse side effects were shown in these patients . Clinical studies with longer follow-up and sample size are needed to confirm these results . CONCLUSIONS We concluded that administration of a symbiotic gel is a safe and simple way to improve common GIS in dialysis patients The objective of the present study was to evaluate bowel habits induced by ingestion of 10 g polydextrose ( PDX ) fed to Japanese hemodialysis ( HD ) patients . This was a r and omized , placebo-controlled , triple-blind , parallel-group controlled , 8-wk study . A total of 50 HD out patients capable of self-management ( 51 - 79 y of age ) were recruited at H Clinic , Japan . Inclusion criteria for participation in the study were ingestion of one or more laxative tablets for more than 3 mo and having received HD for more than 6 mo . The participants were r and omly assigned to 2 groups : A ( 0 g polydextrose/d ; control ) , B ( 10 g polydextrose/d ; PDX ) . The primary outcome measure was stool frequency . Secondary outcomes were stool consistency , abdominal pain , intestinal bloating and clinical biochemistry indexes .  PDX had no significant effect on blood biochemistry indexes . The PDX group showed significant improvements in bowel function ( stool frequency increased from 3.0 times per week to 7.5 times per week ) and reported no laxation problems ( abdominal distention , cramps , and diarrhea ) ( p<0.01 ) . Regular consumption of the PDX products increased dietary fiber intake to recommended levels and improved bowel habits BACKGROUND Stool form scales are a simple method of assessing intestinal transit rate but are not widely used in clinical practice or research , possibly because of the lack of evidence that they are responsive to changes in transit time . We set out to assess the responsiveness of the Bristol stool form scale  to change in transit time . METHODS Sixty-six volunteers had their whole-gut transit time  ( WGTT ) measured with radiopaque marker pellets and their stools weighed , and they kept a diary of their stool form on a 7-point scale and of their defecatory frequency . WGTT was then altered with senna and loperamide , and the measurements were repeated . RESULTS The base-line WGTT measurements correlated with defecatory frequency ( r = 0.35 , P = 0.005 ) and with stool output ( r = -0.41 , P = 0.001 ) but best with stool form ( r = -0.54 , P < 0.001 ) . When the volunteers took senna ( n = 44 ) , the WGTT decreased , whereas defecatory frequency , stool form score , and stool output increased ( all , P < 0.001 ) . With loperamide ( n = 43 ) all measurements changed in the opposite direction . Change in WGTT from base line correlated with change in defecatory frequency ( r = 0.41 , P < 0.001 ) and with change in stool output ( n = -0.54 , P < 0.001 ) but best with change in stool form ( r = -0.65 , P < 0.001 ) . CONCLUSIONS This study has shown that a stool form scale can be used to monitor change in intestinal function . Such scales have utility in both clinical practice and research OBJECTIVES To evaluate the effects of olive oil and flaxseed oil compared with mineral oil for the treatment of constipation in patients undergoing hemodialysis . METHODS A 4-week , double-blind , r and omized , and controlled trial was conducted . Fifty constipated patients ( 29 % male , 51 ± 12 years ) diagnosed by the Rome III criteria were r and omly assigned to receive mineral oil ( control group ; n = 17 ) , olive oil ( n = 16 ) , or flaxseed oil ( n = 17 ) . The initial oil dose was 4 mL/day , and adjustments during the follow-up could be made as needed . The impact of the intervention was assessed by the Rome III criteria scores . RESULTS The most frequent symptoms of constipation evaluated by the Roma III criteria at baseline were comparable among the groups and included " incomplete evacuation " ( 92 % ) , " lumpy or hard stools , " ( 72 % ) and " anorectal obstruction " ( 70 % ) . The Rome III score improved significantly in patients receiving mineral oil ( 10.5 ± 5.0 to 4.1 ± 4.0 ; P < .01 ) , olive oil ( 10.3 ± 4.2 to 3.2 ± 3.8 ; P = .01 ) , and flaxseed oil ( 9.6 ± 4.2 to 6.0 ± 5.1 ; P < .01 ) , with no significant group-by-time interaction ( P = .15 ) . The scores of 5 from 6 constipation symptoms reduced similarly in the mineral oil and olive oil groups , whereas only the frequency of evacuation and the consistency of stools improved in the flaxseed oil group . CONCLUSIONS We demonstrated that the daily use of olive oil or flaxseed oil was as effective as mineral oil in the treatment of constipation in patients undergoing hemodialysis OBJECTIVE The main objective was to investigate whether the prevalences of nausea , vomiting , diarrhea , and reduced appetite varied by gender in  maintenance hemodialysis ( MHD ) patients .  We also evaluated whether these symptoms explain female-male difference in nutritional status . DESIGN Cross section of baseline data of the Prospect i ve Study of the Prognosis in Chronic Hemodialysis Patients . SETTING Dialysis units in the city of Salvador , Brazil . PATIENTS Three hundred ninety-seven men and 287 women with more than three months on MHD .  PREDICTOR VARIABLE Gender . OUTCOME MEASURES The patient 's self-reported nausea , vomiting , diarrhea , and reduced appetite . The malnutrition-inflammation score ( MIS ) was used to assess nutritional status . RESULTS The prevalence of symptoms was 24.3 % for reduced appetite , 19.7 % for nausea , 12.3 % for vomiting , and 3.5 % for diarrhea . In a logistic regression model with adjustments for age , diabetes , congestive heart failure , hemoglobin , albumin , Kt/V , and years on dialysis , women were found to have significantly higher odds of reduced appetite ( odds ratio [ OR ] = 1.97 ) , nausea ( OR = 1.90 ) , and vomiting ( OR = 2.21 ) . MIS was 5.41 ± 3.18 for women and 4.66 ± 3.28 for men ( P = .002 ) corresponding to a percentage difference of 13.86 % . The female-male difference reduced by more than half after excluding the gastrointestinal symptoms component and by approximately 65 % after excluding both the gastrointestinal symptoms and the dietary intake components from the MIS . CONCLUSIONS The results suggest that the prevalences of nausea , vomiting , and reduced appetite are higher in women than in men on MHD . These gastrointestinal symptoms and perhaps their detrimental effects on dietary intake may partially explain a poorer nutritional status in MHD women OBJECTIVE Peritonitis is still one of the major causes of peritoneal dialysis ( PD ) patients ' dropout . In the present study , we analyzed the relationship between gastrointestinal ( GI ) problems and peritonitis in our CAPD patients . METHODS It is a prospect i ve observational study . In December , 2008 , 158 patients on continuous ambulatory peritoneal dialysis ( CAPD ) for more than 3 months from our PD unit were included in this study . A question naire was used to evaluate their GI symptoms score ( GISS ) . All patients were followed up for 24 months or until they dropped out from our PD program . All peritonitis events were recorded . RESULTS The patients ' PD duration was 22 ( 4 - 132 ) months before the study . During the 24 months follow-up , 37 patients dropped out . And 37 patients had 46 episodes of peritonitis ( peritonitis group ) whereas the other 121 patients did not have peritonitis ( peritonitisfree group ) . The overall peritonitis rate was one episode per 75.87 patient months . The peritonitis free group had lower GISS ( 1.35 ± 1.94 vs. 2.95 ± 3.19 , p = 0.006 ) , higher albumin level and longer dialysis duration at baseline as compared to the peritonitis group . Multivariate Cox-regression analysis showed that only GISS ( OR 1.206 , 95 % CI 1.093 - 1.330 ) and dialysis duration ( OR 1.018 , 95 % CI 1.006 - 1.031 ) were the risk factors for the time to first peritonitis episodes during the follow-up . Further analysis identified 2 GISS components , belching and constipation , as the strongest predictors of peritonitis during the follow-up period ( p < 0.005 ) . CONCLUSION Our study showed that GI symptoms could predict peritonitis in CAPD patients . Prevention and treatment for GI problems may thus be helpful to decrease peritonitis rate 
    Output:
    
GI symptoms were heterogeneous , with the reported prevalence highly dependent on the definitions used , inclusion /exclusion criteria , assessment tools and methods used .
The most prevalent symptoms were constipation , indigestion , abdominal pain and reflux .
Medication use and dietary data were poorly reported .
Constipation was more common in HD patients than PD patients .
Indigestion , abdominal pain and reflux were commonly reported in both dialysis modalities .