***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: Several studies with probiotics have shown promising results in the treatment of IBS . One of the probiotics used was saccharomyces boulardii . This is a r and omized double blind placebo controlled clinical trial of S. boulardii in diarrhoea predominant IBS and was carried out in the hospital of Bangab and hu Sheikh Mujib Medical University ( BSMMU ) , Dhaka , Bangladesh from June 2004 to July 2005 . Thirty five ( 35 ) patients were included in each of the control and study groups . The study group was treated with S. boulardii 250 mg twice daily orally for one month . Patients were evaluated before therapy , at the end of therapy and 30 days after end of therapy by a scoring system which included symptoms as well as personal and professional life . No significant difference between the two groups was found in any of the parameters evaluated on any of the observation days . S. boulardii treatment for 30 days in diarrhoea predominant IBS patients did not result in any improvement in this study Background : Functional abdominal pain ( FAP ) is one of the most common diseases , and large percentages of children suffer from it . Objectives : The purpose of the study was to evaluate the effect of Lactobacillus reuteri in treatment of children with functional abdominal pain . Patients and Methods : This study was a r and omized double-blind placebo-controlled trial . Children aged 4 to 16 years with chronic functional abdominal pain ( based on Rome III criteria ) were enrolled in the study . They were r and omly divided into two groups , one receiving probiotic and the other placebo . Results : Forty children received probiotic  and forty others placebo .  There were no significant differences in age , weight , sex , location of pain , associated symptoms , frequency and intensity of pain between the groups . The severity and frequency of abdominal pain in the first month compared to baseline was significantly less and at the end of the second month , there was no significant difference between both groups compared to the end of the first month . Conclusions : This study showed that the severity of pain was significantly reduced in both groups . There was no significant difference in pain scores between them . The effect of probiotic and placebo can probably be attributed to psychological effect of the drugs BACKGROUND Antidepressants are effective in adults with pain-related functional gastrointestinal disorders . We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain ( FAP ) . METHODS Children with FAP , based on the Rome III criteria ( n = 115 , aged 6 - 18 years ) , were r and omized to receive either citalopram 20 mg/day or placebo for 4 weeks . Treatment response was defined as ≥ 2 point reduction in the 6-point Faces pain rating scale or ' no pain ' . Depression , anxiety , somatization , and physician-rated global severity and improvement were also evaluated . Patients were followed up for 8 weeks after medication period . KEY RESULTS Eighty-six patients completed the medication ( 43 in each group ) . Response rate in the citalopram and placebo groups based on per- protocol ( intention-to-treat ) analysis was 55.8 % ( 40.6 % ) and 39.5 % ( 30.3 % ) at week 4 ( p = 0.097 [ 0.169 ] ) and 72.0 % ( 52.5 % ) and 53.4 % ( 41.0 % ) at week 12 ( p = 0.059 [ 0.148 ] ) , respectively . In per- protocol analysis , more reduction was observed in pain ( F = 3.84 , p = 0.024 ) and global severity scores ( F = 4.12 , p = 0.021 ) in the citalopram group compared with the placebo group over the study period . Such differences were not present in the intention-to-treat analysis . No difference was found between the two groups regarding change in depression , anxiety , or somatization score over the study . CONCLUSIONS & INFERENCES Overall , we found a trend toward the effectiveness  of citalopram in the treatment of children with FAP . Trials with longer treatment duration in larger sample s of patients are required in this regard Background : Irritable bowel syndrome ( IBS ) is a common gastrointestinal disorder in children . Recently , probiotics have been suggested as a treatment option for gastrointestinal disorders . The most effective species and the most appropriate doses are still unknown . Objective : The aim of this study was to assess the effects of Lactobacillus GG ( LGG ) for treating IBS in pediatric patients . Methods : In a controlled , double blind , r and omized trial , patients with IBS diagnosed by Rome III criteria from August 2012 to September 2012 at Dr. Sheikh Hospital , Mashhad University of Medical Sciences , Iran , were assigned to one of two groups , i.e. , intervention and control groups . For four weeks , the intervention group received a probiotic in capsule form that contained LGG at a concentration of 1 × 1010 cfu/ml bacteria . For the same period , the control group received a placebo capsule that had the same shape and color but only contained inulin , which also was present in the LGG capsules . The primary outcome was any change in the severity of the patients ’ pain , and we used a five-point Likert scale to evaluate the severity of their pain . Secondary outcomes were ghanges of the functional scale , stool patterns , and associated problems . Results : Fifty-two patients participated in the study , and 26 patients were assigned r and omly to each of the two groups . The severity of the patients ’ pain decreased significantly in the intervention group after one , two , three , and four weeks of treatment , as indicated by P-values of 0.01 , 0.00 , 0.00 , and 0.00 , respectively . Also , there was significant improvement in the functional scale after two weeks of treatment ( P-value ≤ 0.00 ) . Conclusion : Lactobacillus GG at a concentration of 1 × 1010 cfu/ml for a period of four weeks can lessen the severity of the patients ’ pain and improve the functional scale in patients with irritable bowel syndrome . Probiotics can have therapeutic effects for IBS patients Abstract The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominal pain . The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominal pain ( N = 104 ) and well children ( N = 119 ) , ages 8–16 years . Parents were r and omly assigned and trained to interact with their children according to one of three conditions : Attention , Distraction , or No Instruction . Children 's symptom complaints and parents ' responses were audiotaped and coded . Children completed a self‐report measure of gastrointestinal ( GI ) symptoms before and after interacting with their parents . Parents ' and children 's perceptions of their interaction were assessed . Compared to the No Instruction condition , symptom complaints by pain patients and well children nearly doubled in the Attention condition and were reduced by half in the Distraction condition . The effect of attention on symptom complaints was greater for female pain patients than for male patients or well children . Findings for self‐report GI symptoms were similar to those for audiotaped symptom complaints . Both pain patients and well children in the Distraction condition rated parents as making them feel better compared to ratings for the Attention condition . Parents of pain patients rated distraction as having greater potential negative impact on their children than attention . Parents ' responses to children 's symptom complaints can significantly increase or decrease those complaints . Girls with functional abdominal pain are particularly vulnerable to the symptom‐reinforcing effects of parental attention AIM The management of functional abdominal pain ( FAP ) in children and adolescents is challenging for health care professionals , and there are only limited or inconclusive studies of pharmacologic or behavioral therapy in childhood FAP . The objective of this r and omized placebo-controlled clinical trial was to determine the potential efficacy and safety of cyproheptadine in the treatment of pediatric FAP . METHODS Between January 2006 and March 2007 , 29 clinical ly referred children and adolescents with FAP ( aged 4.5 to 12 years ) completed a 2-week , double-blinded r and omized placebo-controlled trial of cyprohetadine . Primary outcome measure was the self-reported change of frequency and duration of abdominal pain by using a 6-point scale , and the parents ' impression or assessment of the children 's improvement . RESULTS By week 1 and 2 of the intervention , the intensity and frequency of abdominal pain among the patients treated with cyproheptadine , were rated as complete resolved and very much improved or improved for 3 ( 20 % ) , 10 ( 66.6 % ) , respectively . However , in the placebo-receiver children , these scales had no change in 7 ( 50 % ) , rated as improved or very much improved in 5 ( 35.7 % ) , and become worse in 2 ( 14.3 % ) . The patients ' self-reported and the parents ' impression in the cyproheptadine group were significantly better than it in the placebo group ( P=0.003 ) . CONCLUSION Among children with functional abdominal pain , cyproheptadine is enough effective to improve the intensity and frequency of abdominal pain in a short-term period BACKGROUND Analgesics for children with acute abdominal pain are often withheld for fear that they might mask physical examination findings and thus might be unsafe . This viewpoint has been challenged recently . OBJECTIVE To evaluate the effects of buccal oxycodone on pain relief , physical examination findings , diagnostic accuracy , and final clinical outcomes in children with acute abdominal pain . DESIGN Prospect i ve , r and omized , double-blind , and placebo-controlled trial between December 2001 and November 2003 . SETTING University teaching hospital in Finl and . Patients A total of 104 children aged 4 to 15 years with abdominal pain of less than 7 days ' duration were screened , and 63 children with pain scores of 5 or higher on a 10-cm visual analog scale were eligible for the trial . Intervention Children were r and omized to receive buccally either 0.1 mg/kg(-1 ) of oxycodone hydrochloride ( n = 32 ) or the same volume of normal saline ( n = 31 ) . The same surgeon described the physical findings and indicated a provisional diagnosis and a provisional disposition before the children received the study medication and at 1 hour and 3.5 hours after initial dosing . Pain scores were recorded at baseline and every 30 minutes for 3.5 hours after the first study drug administration . MAIN OUTCOME MEASURES Pain intensity difference , presence or absence of abdominal guarding , and diagnostic accuracy . RESULTS The demographic characteristics , initial pain scores , and physical signs and symptoms were similar between the 2 groups . Both study drugs were associated with decreasing pain scores . The summed pain intensity difference over 7 observations was significantly greater in the oxycodone group , 22 + /- 18 cm , than in the placebo group , 9 + /- 12 cm ( mean difference 13 cm , with a 95 % confidence interval of 2 - 24 cm ; P = .04 ) . The diagnostic accuracy increased from 72 % to 88 % in the oxycodone group and remained at 84 % in the placebo group after study drug administration . Laparotomy was performed in 17 patients in the oxycodone group and in 14 patients in the placebo group . Four patients without appendicitis underwent exploratory laparotomy in each group . One patient in the placebo group was initially diagnosed as having nonspecific abdominal pain , but at 14 hours , she was operated on for appendiceal perforation . CONCLUSIONS Early administration of buccal oxycodone provides a significant pain relief to children with acute abdominal pain , without adversely altering the clinical signs or obscuring the surgical diagnosis Aim : We evaluated the effectiveness of a synbiotic in the treatment of childhood functional abdominal pain ( FAP ) . Background : Probiotics are effective in the treatment of functional gastrointestinal disorders in adult patients , but there is lack of information in children . Patients and methods : Children with FAP , based on the Rome III criteria ( n = 115 , aged 6 - 18 years ) , were r and omized to receive either synbiotic ( Bacillus coagulans , Unique IS-2 , 150 million spore plus FOS , 100 mg ) twice daily or placebo for four weeks . Treatment response was defined as ≥ 2-point reduction in the 6-point self-rated pain scale or “ no pain ” . Physician-rated global severity and improvement were also evaluated . Patients were followed for a total of 12 weeks . Results : Eighty-eight patients completed the trial ( 45 with synbiotic ) . Response rate was higher with synbiotic than placebo after medication ( 60 % vs. 39.5 % , P = 0.044 ) , but was not different between the two groups at week 12 ( 64.4 % vs. 53.4 % , P = 0.204 ) . Difference between the two groups regarding the physician-rated global severity over the study period was not statistically significant ( z = -1.87 , P = 0.062 ) . There was no significant difference between the two groups in physician-rated global improvement ( week 4 , P = 0.437 ; week 12 , P = 0.111 ) . Receiving synbiotic ( OR 2.608 , 95 % CI : 1.01 - 6.68 ) and baseline pain score ( OR 2.21 , 95 % CI : 1.19 - 4.10 ) were predictors of treatment response after medication . Conclusion : The synbi 
    Output:
    
Conclusions Approximately 41 % of children with abdominal pain‐related functional gastrointestinal disorders improve on placebo .
Several trial characteristics are correlated significantly with the proportion of patients with no pain on placebo and with the magnitude of the placebo response on Faces Pain Scales .