***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: Background And Objective : Gastric acidity is a major nonimmune defense mechanism against infections . The objective of this study was to investigate whether ranitidine treatment in very low birth weight ( VLBW ) infants is associated with an increased risk of infections , necrotizing enterocolitis ( NEC ) , and fatal outcome . Methods : Newborns with birth weight between 401 and 1500 g or gestational age between 24 and 32 weeks , consecutively observed in neonatal intensive care units , were enrolled in a multicenter prospect i ve observational study . The rates of infectious diseases , NEC , and death in enrolled subjects exposed or not to ranitidine were recorded . Results : We evaluated 274 VLBW infants : 91 had taken ranitidine and 183 had not . The main clinical and demographic characteristics did not differ between the 2 groups . Thirty-four ( 37.4 % ) of the 91 children exposed to ranitidine and 18 ( 9.8 % ) of the 183 not exposed to ranitidine had contracted infections ( odds ratio 5.5 , 95 % confidence interval 2.9–10.4 , P < .001 ) . The risk of NEC was 6.6-fold higher in ranitidine-treated VLBW infants ( 95 % confidence interval 1.7–25.0 , P = .003 ) than in control subjects . Mortality rate was significantly higher in newborns receiving ranitidine ( 9.9 % vs 1.6 % , P = .003 ) . Conclusions : Ranitidine therapy is associated with an increased risk of infections , NEC , and fatal outcome  in VLBW infants . Caution is advocated in the use of this drug in neonatal age Objectives : Gastroesophageal reflux ( GER ) is a frequently occurring condition in infants capable of causing distressing symptoms . The aim of our study is to evaluate the efficacy of Mg alginate plus simethicone ( Gastrotuss Baby , DMG Italia SRL , Pomezia , Italy ) , compared with rice-starch – thickened formula or with reassurance alone , in the treatment of GER in infants . Methods : The present r and omized controlled trial was conducted in full-term infants affected by symptoms suggestive of GER , evaluated through a vali date d question naire ( Infant Gastroesophageal Reflux Question naire Revised ) . The patients were r and omized into 3 groups according to treatment ( group A : Mg alginate plus simethicone ; group B : thickened formula ; group C : reassurance with lifestyle changes ) . Evaluation of symptom scores was performed after 1 month ( T1 ) and 2 months ( T2 ) . Results : A total of 64 ( 85.3 % ) of 75 enrolled infants ( median age 5 months ; range 1–10 ) concluded the study . After 1 month of treatment ( T1 ) , infants treated with Mg alginate plus simethicone showed a statistically significant improvement in symptoms compared with the thickened formula and reassurance ( P < 0.03 , < 0.0001 , respectively ) . At the end of the study , all 3 groups of patients showed a significant reduction in symptom scores ( P < 0.002 , < 0.038 , < 0.03 , respectively ) . Median symptom score values were more significantly reduced in group A than in group B and in group C ( group A vs group B P < 0.002 ; group A vs group C P < 0.0001 ; group B vs group C P < 0.001 ) . Conclusions : Mg alginate plus simethicone seems to be more efficacious on GER symptom scores than thickened formula and reassurance with lifestyle changes alone OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review OBJECTIVE . Our aim was to compare 2 laxatives , namely , polyethylene glycol 3350 without electrolytes and milk of magnesia , evaluating the efficacy , safety , acceptance , and 1-year outcomes . METHODS . Seventy-nine children with chronic constipation and fecal incontinence were assigned r and omly to receive polyethylene glycol or milk of magnesia and were treated for 12 months in tertiary care pediatric clinics . Children were counted as improved or recovered depending on resolution of constipation , fecal incontinence , and abdominal pain after 1 , 3 , 6 , and 12 months . An intent-to-treat analysis was used . Safety was assessed with evaluation of clinical adverse effects and blood tests . RESULTS . Thirty-nine children were assigned r and omly to receive polyethylene glycol and 40 to receive milk of magnesia . At each follow-up visit , significant improvement was seen in both groups , with significant increases in the frequency of bowel movements , decreases in the frequency of incontinence episodes , and resolution of abdominal pain . Compliance rates were 95 % for polyethylene glycol and 65 % for milk of magnesia . After 12 months , 62 % of polyethylene glycol-treated children and 43 % of milk of magnesia-treated children exhibited improvement , and 33 % of polyethylene glycol-treated children and 23 % of milk of magnesia-treated children had recovered . Polyethylene glycol and milk of magnesia did not cause clinical ly significant side effects or blood abnormalities , except that 1 child was allergic to polyethylene glycol . CONCLUSIONS . In this r and omized study , polyethylene glycol and milk of magnesia were equally effective in the long-term treatment of children with constipation and fecal incontinence .  Polyethylene glycol was safe for the long-term treatment of these children and was better accepted by the children than milk of magnesia ABSTRACT . The effect of Simethicone on  “ colicky ” ( n=27 ) infants was tested in a double‐blind cross‐over study . Three different parameters were used to measure the efficiency of the treatment : interviews , 24‐hour records and behavioral observations . No effects of Simethicone on the symptoms of infantile colic could be demonstrated . However , 67 % of the infants improved during the treatment , which could be ascribed to a high‐ grade placebo‐effect OBJECTIVE To investigate the efficacy and safety of polyethylene glycol ( PEG ) 3350 in the treatment of childhood fecal impaction . METHODS This was a prospect i ve , double-blind , parallel , r and omized study of 4 doses of PEG 3350 ; 0.25 g/kg per day , 0.5 g/kg per day , 1 g/kg per day , 1.5 g/kg per day , given for 3 days in children with constipation for > 3 months and evidence of fecal impaction . RESULTS Forty patients completed the study ( 27 boys , median age 7.5 , range 3.3 - 13.1 years ) .  Disimpaction occurred in 75 % of children , with a significant difference between the two higher doses and the lower doses ( 95 % vs 55 % , P < .005 ) . All groups had an increased number of bowel movements during the 5-day study versus baseline , respectively : 6.5 versus 1.1 ( P < .005 ) , 8.0 versus 1.3 ( P < .005 ) , 10.9 versus 1.7 ( P < .005 ) , and 12.3 versus 1.4 ( P < .005 ) . Adverse effects included nausea ( 5 % ) , vomiting ( 5 % ) , bloating ( 18 % ) , cramping ( 5 % ) , and diarrhea ( 13 % ) . Diarrhea and bloating were more prevalent ( P < .02 ) in the higher-dose than in the lower-dose group . No clinical ly significant changes in electrolytes were noted . CONCLUSIONS The 3-day administration of PEG 3350 is safe and effective in the treatment of childhood fecal impaction at doses of 1 and 1.5 g/kg per day OBJECTIVE : We hypothesized that enemas and polyethylene glycol ( PEG ) would be equally effective in treating rectal fecal impaction ( RFI ) but enemas would be less well tolerated and colonic transit time ( CTT ) would improve during disimpaction . METHODS : Children ( 4–16 years ) with functional constipation and RFI participated . One week before disimpaction , a rectal examination was performed , symptoms of constipation were recorded , and the first CTT measurement was started . If RFI was determined , then patients were assigned r and omly to receive enemas once daily or PEG ( 1.5 g/kg per day ) for 6 consecutive days . During this period , the second CTT measurement was started and a child 's behavior question naire was administered . Successful rectal disimpaction , defecation and fecal incontinence frequencies , occurrence of abdominal pain and watery stools , CTTs ( before and after disimpaction ) , and behavior scores were assessed . RESULTS : Ninety-five patients were eligible , of whom 90 participated ( male , n = 60 ; mean age : 7.5 ± 2.8 years ) . Forty-six patients received enemas and 44 PEG , with 5 dropouts in each group . Successful disimpaction was achieved with enemas ( 80 % ) and PEG ( 68 % ; P = .28 ) . Fecal incontinence and watery stools were reported more frequently with PEG ( P < .01 ) , but defecation frequency ( P = .64 ) , abdominal pain ( P = .33 ) , and behavior scores were comparable between groups . CTT normalized equally ( P = .85 ) in the 2 groups . CONCLUSION : Enemas and PEG were equally effective in treating RFI in children . Compared with enemas , PEG caused more fecal incontinence , with comparable behavior scores . The treatments should be considered equally as first-line therapy for RFI 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 Introduction : Proton pump inhibitor ( PPI ) ther 
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Results We found no evidence -based guidelines or systematic review s about the utility of pharmacological therapy  in functional regurgitation , infant colic and functional diarrhea .
In case of regurgitation associated with marked distress , some evidence s support a short trial with alginate when other non pharmacological approach failed ( stepped-care approach ) .
In constipated infants younger than 6 months of age  Lactulose is recommended , whilst in older ages Polyethylene glycol ( PEG ) represents the first-line therapy both for fecal disimpaction and maintenance therapy of constipation .
Conversely , no evidence supports the use of laxatives for dyschezia .
Furthermore , we found no RCTs regarding the pharmacological treatment of cyclic vomiting syndrome , but retrospective studies showed a high percentage of clinical response using cyproheptadine , propanolol and pizotifen .
Conclusion There is some evidence that a pharmacological intervention is necessary for rectal disimpaction in childhood constipation and that PEG is the first line therapy .
In contrast , for the other early FGIDs there is a lack of well- design ed high- quality RCTs and no evidence on the use of pharmacological therapy was found