***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 
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    ***EXAMPLES*** 
    Input: 33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks . 20 improved , 11 of whom lost almost all their symptoms . Short-term improvement was maintained for 3 months without further formal treatment . Hypnotherapy in groups of up to 8 patients was as effective as individual therapy OBJECTIVES : Irritable bowel syndrome is the most common gastrointestinal diagnosis . The symptoms of irritable bowel syndrome are similar to those of small intestinal bacterial overgrowth . The purpose of this study was to test whether overgrowth is associated with irritable bowel syndrome and whether treatment of overgrowth reduces their intestinal complaints . METHODS : Two hundred two subjects in a prospect i ve data base of subjects referred from the community undergoing a lactulose hydrogen breath test for assessment of overgrowth were Rome I criteria positive for irritable bowel syndrome . They were treated with open label antibiotics after positive breath test . Subjects returning for follow-up breath test to confirm eradication of overgrowth were also assessed . Subjects with inflammatory bowel disease , abdominal surgery , or subjects demonstrating rapid transit were excluded . Baseline and after treatment symptoms were rated on visual analog scales for bloating , diarrhea , abdominal pain , defecation relief , mucous , sensation of incomplete evacuation , straining , and urgency . Subjects were blinded to their breath test results until completion of the question naire . RESULTS : Of 202 irritable bowel syndrome patients , 157 ( 78 % ) had overgrowth . Of these , 47 had follow-up testing . Twenty-five of 47 follow-up subjects had eradication of small intestinal bacterial overgrowth . Comparison of those that eradicated to those that failed to eradicate revealed an improvement in irritable bowel syndrome symptoms with diarrhea and abdominal pain being statistically significant after Bonferroni correction ( p < 0.05 ) . Furthermore , 48 % of eradicated subjects no longer met Rome criteria ( χ2= 12.0 , p < 0.001 ) . No difference was seen if eradication was not successful . CONCLUSIONS : Small intestinal bacterial overgrowth is associated with irritable bowel syndrome . Eradication of the overgrowth eliminates irritable bowel syndrome by study criteria in 48 % of subjects BACKGROUND The cause of irritable bowel syndrome ( IBS ) is unknown . It may follow gastroenteritis and be associated with an abnormal gut flora and with food intolerance . Our study was design ed to assess whether these factors were associated with colonic malfermentation . METHODS We carried out a crossover controlled trial of a st and ard diet and an exclusion diet matched for macronutrients in six female IBS patients and six female controls . During the final 72 h on each diet , faecal excretion of fat , nitrogen , starch , and non-starch polysaccharide NSP was measured , and total excretion of hydrogen and methane collected over 24 h in a purpose -built 1.4 m3 whole-body calorimeter . Breath hydrogen and methane excretion were then measured for 3 h after 20 g oral lactulose . FINDINGS The maximum rate of gas excretion was significantly greater in patients than in controls ( 2.4 mL/min IQR 1.7 - 2.6 vs 0.6 , 0.4 - 1.1 ) . Although total gas production in patients was not greater than in controls ( median 527 mL/24 h IQR 387 - 660 vs 412 , 234 - 507 ) , hydrogen production was higher ( 332 , 318 - 478 vs 162 , 126 - 217 , p=0.009 ) . In patients , the exclusion diet reduced symptoms and produced a fall in maximum gas excretion ( 0.5 mL/min IQR 0.3 - 0.7 ) . After lactulose , breath hydrogen was greater on the st and ard than on the exclusion diet . INTERPRETATION Colonic-gas production , particularly of hydrogen , is greater in patients with IBS than in controls , and both symptoms and gas production are reduced by an exclusion diet . This reduction may be associated with alterations in the activity of hydrogen-consuming bacteria . Fermentation may be an important factor in the pathogenesis of IBS CONTEXT Irritable bowel syndrome ( IBS ) is a common functional bowel disorder for which there is no reliable medical treatment . OBJECTIVE To determine whether Chinese herbal medicine ( CHM ) is of any benefit in the treatment of IBS . DESIGN R and omized , double-blind , placebo-controlled trial conducted during 1996 through 1997 . SETTING Patients were recruited through 2 teaching hospitals and 5 private practice s of gastroenterologists , and received CHM in 3 Chinese herbal clinics . PATIENTS A total of 116 patients who fulfilled the Rome criteria , an established st and ard for diagnosis of IBS . INTERVENTION Patients were r and omly allocated to 1 of 3 treatment groups : individualized Chinese herbal formulations ( n = 38 ) , a st and ard Chinese herbal formulation ( n = 43 ) , or placebo ( n = 35 ) . Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist . Patients , gastroenterologists , and herbalists were all blinded to treatment group . MAIN OUTCOME MEASURES Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients . RESULTS Compared with patients in the placebo group , patients in the active treatment groups ( st and ard and individualized CHM ) had significant improvement in bowel symptom scores as rated by patients ( P=.03 ) and by gastroenterologists ( P=.001 ) , and significant global improvement as rated by patients ( P=.007 ) and by gastroenterologists ( P=.002 ) . Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms ( P=.03 ) . Chinese herbal formulations individually tailored to the patient proved no more effective than st and ard CHM treatment . On follow-up 14 weeks after completion of treatment , only the individualized CHM treatment group maintained improvement . CONCLUSION Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS Twenty patients with irritable bowel syndrome ( IBS ) were r and omly assigned either to intensive , individualized cognitive therapy ( 10 sessions over 8 weeks ) or to 8 weeks of daily gastrointestinal ( GI ) symptom monitoring . Pre- to posttreatment evaluations showed significantly ( p = .005 ) greater GI symptom reduction for those receiving cognitive therapy than for those in symptom monitoring . At posttreatment , 80 % of the cognitive therapy group showed clinical ly significant improvement , whereas only 10 % of the monitoring group showed this . Results held up well at a 3-month follow-up . Within the cognitive therapy group , GI symptom reductions correlated significantly with increases in positive and reductions in negative automatic thoughts The aim of this study was to evaluate the effect of a novel laxative preparation , composed of cel and in , aloevera and psyllium in patients with chronic constipation . Thirty-five men and women were r and omized to receive capsules containing cel and in-aloevera-psyllium , or placebo , in a double-blind trial lasting 28 days . Symptoms in the last 2 weeks of the treatment period were compared to those in the 14-day pre-trial basal period . In the cel and in , aloevera and psyllium group , bowel movements became more frequent , the stools were softer and laxative dependence was reduced . In the placebo group , all these parameters were unchanged . Abdominal pain was not reduced in either group . The results of this study show that the preparation is an effective laxative in the treatment of constipation 30 patients with severe refractory irritable-bowel syndrome were r and omly allocated to treatment with either hypnotherapy or psychotherapy and placebo . The psychotherapy patients showed a small but significant improvement in abdominal pain , abdominal distension , and general well-being but not in bowel habit . The hypnotherapy patients showed a dramatic improvement in all features , the difference between the two groups being highly significant . In the hypnotherapy group no relapses were recorded during the 3-month follow-up period , and no substitution symptoms were observed A double-blind crossover trial of oligofructose ( Raftilose P95 ) 2 g three times daily against sucrose ( 1 g ) three times daily was performed in patients suffering from irritable bowel syndrome . Each treatment was followed for 4 wk . Patients consumed a st and ardized diet during the last 14 d of each treatment period , and symptoms were assessed using a previously vali date d question naire . Fecal weight and pH , whole-gut transit time and fasting breath hydrogen concentrations were measured at the start of the study and at the end of each treatment period . Oligofructose produced no significant change in any of these parameters even when patients were divided into those with predominant diarrhea ( n = 14 ) and those with predominant constipation ( n = 7 ) . Oligofructose at a dose of 6 g/d had no therapeutic value in patients with irritable bowel syndrome One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy , relaxation , and st and ard medical treatment compared with st and ard medical treatment alone .  Patients were only selected if their symptoms had not improved with st and ard medical treatment over the previous 6 months . At 3 months , the treatment group showed significantly greater improvement than the controls on both gastroenterologists ' and patients ' ratings of diarrhea and abdominal pain , but constipation changed little . Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress , whereas those with constant abdominal pain were helped little by this treatment . This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to st and ard medical treatment In a double-blind , crossover study , wedetermined whether microencapusulated pancreatic enzymesreduce  postpr and ial symptoms experienced by healthyvolunteers after ingestion of a high calorie , high fat meal . At 7 AM , 18 subjects ingested 185 g ofcookies ( 1196 calories and 72 g of fat ) with threepancrelipase capsules or a placebo . The severity ofgastrointestinal symptoms and flatus passages wererecorded for 15 - 17 hr , and end-alveolar sample s wereobtained hourly for 10 hr . Ingestion of pancreaticsupplements was associated with a significant ( P = 0.049 ) reduction in bloating over the entire recordingperiod , and with significant reductions in bloating , gas , and fullness during the dinner to bedtime period . Pancreatic supplements had no significant effect onbreath H2 or CH4 concentration . The finding that pancreatic supplements reduce postpr and ial symptoms inhealthy subjects suggests that these supplements alsomight be beneficial in irritable bowelsyndrome Previous research from the United Kingdom has shown hypnotherapy to be effective in the treatment of irritable bowel syndrome ( IBS ) . The current study provides a systematic replication of this work in the United States . Six matched pairs of IBS patients were r and omly assigned to either a gut-directed hypnotherapy ( n=6 ) or to a symptom monitoring wait-list control condition ( n=6 ) in a multiple baseline across subjects design . Those assigned to the control condition were later crossed over to the treatment condition . Subjects were matched on concurrent psychiatric diagnoses , susceptibility to hypnosis , and various demographic features . On a composite measure of primary IBS symptoms , treatment was superior ( p=.016 ) to symptom monitoring . Results from the entire treated sample ( n=11 ; one subject was removed from analysis ) indicate that the individual symptoms of abdominal pain , constipation , and flatulence improved significantly . State and trait anxiety scores were also seen to decrease significantly . Results at the 2-month follow-up point indicated good maintenance of treatment gains . No significant correlation was found between initial susceptibility to hypnosis and treatment gain . A positive relationship was found between the incidence of psychiatric diagnosis and overall level of improvement The effectiveness of ginger ( Zingiber officinale ) as an antiemetic agent was compared with placebo and metoclopramide in 60 women who had major gynaecological surgery in a double‐blind , r and omised study . There were statistically significantly fewer recorded incidences of nausea in the group that received ginger root compared with placebo ( p < 0.05 ) . The number of incidences of nausea in the groups that received either ginger root or metoclopramide were similar . The administration of antiemetic after operation was significantly greater in the placebo group compared to the other two groups ( p < 0.05 ) BACKGROUND Symptoms of at least a subgroup of patients with irritable bowel syndrome may be associated with an alteration in gut flora . Studies on bacterial based therapy have yielded mixed results . AIMS To determine if oral administration of the probiotic Lactobacillus casei strain GG under r and omized placebo controlled conditions improves symptoms in irritable bowel syndrome patients with bloating related symptoms . PATIENTS A total of 25 patients with clinical ly confirmed irritable bowel syndrome ( Rome criteria ) were enrolled in the study . METHODS This was a r and omised double-blind placebo-controlled crossover 
    Output:
    
Oral cromolyn sodium may be useful in chronic unexplained diarrhea and appears as effective as and safer than elimination diets .
Alterations of enteric flora may play a role in irritable bowel syndrome , but supporting evidence for bacterial overgrowth or probiotic therapy is lacking