***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 Constipation and encopresis are common problems in children . Still today , the role of fiber in the treatment of chronic constipation in childhood is controversial . The aim of our study was to evaluate whether fiber supplementation is beneficial in the treatment of children with functional constipation with or without encopresis . We used glucomannan as the fiber supplement . METHODS We evaluated the effect of fiber ( glucomannan , a fiber gel polysaccharide from the tubers of the Japanese Konjac plant ) and placebo in children with chronic functional constipation with and without encopresis in a double-blind , r and omized , crossover study . After the initial evaluation , the patients were disimpacted with 1 or 2 phosphate enemas if a rectal impaction was felt during rectal examination . Patients continued with their preevaluation laxative . No enemas were given during each treatment period . Fiber and placebo were given as 100 mg/kg body weight daily ( maximal 5 g/day ) with 50 mL fluid/500 mg for 4 weeks each . Parents were asked to have children sit on the toilet 4 times daily after meals and to keep a stool diary . Age , frequency of bowel movements into the toilet and into the undergarment , presence of abdominal pain , dietary fiber intake , medications , and the presence of an abdominal and /or a rectal fecal mass were recorded on a structured form at the time of recruitment and 4 weeks and 8 weeks later . Children were rated by the physician as successfully treated when they had > or =3 bowel movements/wk and < or = 1 soiling/3 weeks with no abdominal pain in the last 3 weeks of each 4-week treatment period . Parents made a global assessment s to whether they believed that the child was better during the first or second treatment period . RESULTS Forty-six chronically constipated children were recruited into the study , but only 31 children completed the study . These 31 children ( 16 boys and 15 girls ) were 4.5 to 11.7 years of age ( mean : 7 + /- 2 years ) . All children had functional constipation ; in addition , 18 had encopresis when recruited for the study . No significant side effects were reported during each 4-week treatment period . Significantly fewer children complained of abdominal pain and more children were successfully treated while on fiber ( 45 % ) as compared with placebo treatment ( 13 % ) . Parents rated significantly more children ( 68 % ) as being better on  fiber versus 13 % as being better on placebo . The initial fiber intake was low in 22 ( 71 % ) children . There was no difference in the percentage of children with low fiber intake living in the United States ( 70 % ) and Italy ( 71 % ) . Successful treatment ( physician rating ) and improvement ( parent rating ) were independent of low or acceptable initial fiber intake . The duration of chronic constipation ranged from 0.6 to 10 years ( mean : 4.0 + /- 2.5 years ) . Duration of constipation did not predict response to fiber treatment . Children with constipation only were significantly more likely to be treated successfully with fiber ( 69 % ) than those with constipation and encopresis ( 28 % ) . CONCLUSION We found glucomannan to be beneficial in the treatment of constipation with and without encopresis in children . Symptomatic children who were already on laxatives still benefited from the addition of fiber . Therefore , we suggest that we continue with the recommendation to increase the fiber in the diet of constipated children with and without encopresis BACKGROUND & AIMS : Dietary fructans exacerbate symptoms in some , but not all , adults with irritable bowel syndrome ( IBS ) . We sought to determine whether fructans worsen symptoms in children with IBS and whether clinical and psychosocial factors , and /or gas production , can identify those who are fructan sensitive . METHODS : We performed a double‐blind placebo‐controlled ( maltodextrin ) cross‐over trial of 23 children with IBS , based on pediatric Rome III criteria , from September 2014 through December 2016 . At baseline , participants completed 1‐week pain and stool diaries and a 3‐day food record and psychosocial factors ( depression , anxiety , and somatization ) were measured . Subjects were r and omly assigned to groups that were provided meals for 72 hours containing either fructans or maltodextrin ( 0.5 g/kg ; maximum , 19 g ) . Following a washout period of 10 days or more , the subjects received the meal they were not given during the first study period ( crossed over ) . Gastrointestinal symptoms and breath hydrogen and methane production were captured during each meal period . Fructan sensitivity was defined as an increase of 30 % or more in abdominal pain frequency following fructan ingestion . RESULTS : Subjects had more mean episodes of abdominal pain/day during the fructan‐containing diet ( 3.4 ± 2.6 ) vs the maltodextrin‐containing diet ( 2.4 ± 1.7 ) ( P < .01 ) , along with more severe bloating ( P < .05 ) and flatulence ( P = .01 ) . Hydrogen ( but not methane ) production was greater while subjects were on the fructan‐containing diet ( 617 ± 305 ppm*h ) than the maltodextrin‐containing diet ( 136 ± 78 ppm*h ) ( P < .001 ) . Eighteen subjects ( 78.2 % ) had more frequent abdominal pain while on the fructan‐containing diet and 12 ( 52.2 % ) qualified as fructan sensitive . We found no difference between fructan‐sensitive and fructan‐insensitive subjects in baseline abdominal pain or bowel movement characteristics , dietary intake , psychosocial parameters , IBS subtype , or gas production . CONCLUSIONS : In a r and omized controlled trial of children with IBS , we found fructans to exacerbate several symptoms . However , fructan sensitivity can not be identified based on baseline gastrointestinal symptoms , dietary intake , psychosocial factors , or gas production . Clinical trials.gov no : NCT02842281 Objective : The aim of the present study was to evaluate the treatment adherence  of children with chronic functional constipation . Methods : The present study is a prospect i ve and longitudinal study realized at a pediatric gastroenterology clinic of a Brazilian University Hospital , between August 2009 and October 2011 . Rome III criteria and the Bristol Stool Scale were used to define constipation and to characterize feces , respectively . Drug treatment was prescribed for patients according to the protocol s previously st and ardized in the clinic . Specific question naires , containing questions related to 1 dependent variable and independent variables were completed in the first and sixth months of the treatment . Independent variables related to the patients , their caregivers , the disease itself , and the therapeutic plan were analyzed and compared with the dependent variable ( adherence to the treatment ) . Adherence was considered when the patient returned with > 75 % of the prescribed medicine containers empty . Results : Fifty children participated in both the first and sixth months of treatment . The mean age of the sample was 77.6 ± 43.8 months and the mean age of the onset of symptoms was 18.8 ± 27.9 months . The adherence rate was 38 % in the first month and 30 % in the sixth month . Patients who were treated with polyethylene glycol had greater adherence than patients who were prescribed other laxatives , with statistical significance in the second moment of the study ( P = 0.19 and P = 0.04 , respectively ) . Conclusions : The study showed low adherence rates to drug treatment of constipation in children . It is necessary to seek new strategies to increase treatment adherence , while avoiding complications and reducing costs BACKGROUND & AIMS Treatment measures for constipation in children are often not satisfactory . The aim was to assess the efficacy of glucomannan ( GNN ) as a sole treatment for functional constipation . METHODS Children aged 3 - 16 years with functional constipation according to Rome III criteria were r and omly assigned to receive GNN ( 2.52 g/d ) or placebo for 4 weeks . RESULTS Of the 80 children , 72 ( 90 % ) completed the study . The primary outcome , treatment success ( ≥3 stools per week with no soiling ) , was similar in the GNN ( n = 36 ) and placebo ( n = 36 ) groups ( relative risk 0.95 , 95 % CI 0.6 to 1.4 ) . In the GNN group , the stool consistency score was higher at week 1 ( P < 0.0001 ) , lower at week 3 ( P = 0.008 ) , and similar at weeks 2 and 4 . Stool frequency was higher only at week 3 ( P = 0.007 ) . Abdominal pain episodes were more frequent in the GNN group at week 1 ( P = 0.04 ) and week 4 ( P < 0.0001 ) but were similar between groups at weeks 2 and 3 . No difference was observed in the frequency of any other secondary outcome or adverse event . CONCLUSIONS In our setting , GNN , as dosed in this study , was not more effective than placebo in achieving therapeutic success in constipated children . The trial was registered at Clinical Trials.gov ( http:// clinical trials.gov ) , number NCT01151878 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 : Constipation is a pediatric problem commonly encountered by many health care workers in primary , secondary , and tertiary care . To assist medical care providers in the evaluation and management of children with functional constipation  , the North American Society for Pediatric Gastroenterology , Hepatology , and Nutrition and the European Society for Pediatric Gastroenterology , Hepatology , and Nutrition were charged with the task of developing a uniform document of evidence -based guidelines . Methods : Nine clinical questions addressing diagnostic , therapeutic , and prognostic topics were formulated . A systematic literature search was performed from inception to October 2011 using Embase , MEDLINE , the Cochrane Data base of Systematic Review s and Cochrane Central Register of Controlled Clinical Trials , and PsychInfo data bases . The approach of the  Grading of Recommendations Assessment , Development and Evaluation  was applied to evaluate outcomes . For therapeutic questions , quality of evidence was assessed using the Grading of Recommendations , Assessment , Development , and Evaluation system . Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence -Based Medicine . During 3 consensus meetings , all recommendations were discussed and finalized . The group members voted on each recommendation , using the nominal voting technique . Expert opinion was used where no r and omized controlled trials were available to support the recommendation . Results : This evidence -based guideline provides recommendations for the evaluation and treatment of  children with functional constipation  to st and ardize and improve their quality of care . In addition , 2 algorithms were developed , one for the infants < 6 months of age and the other for older infants and children . Conclusions : This document is intended to be used in daily practice and as a basis for further clinical research . Large well- design ed clinical trials are necessary with regard to diagnostic evaluation and treatment Background Dietary fiber ( DF ) intake in American children is suboptimal , increasing the risk of GI distress and contributing to poor diet quality . The objective of this study was to determine the effect of introducing two high-fiber snacks per day on gastrointestinal function as well as nutrient and food group intake in health 
    Output:
    
Most studies on the use of fiber for the treatment of FC and IBS have shown its benefit .
However , due to the heterogeneity in study design , length of treatment , outcome measures , and amount and type of fiber , we were unable to make a definitive recommendation supporting the use of fiber for the treatment of FC and IBS in children