human
***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: Complications of Crohn ’s disease ( CD ) lead to surgery in about 70–90 % of patients . The majority of patients suffer from relapse of the disease . Colonic bacteria are essential to the development of CD . Therefore , a rationale exists in trying to prevent relapse by manipulation of gut microflora . This is feasible by treatment with probiotics or antibiotics . Synbiotic 2000 is a cocktail containing 4 probiotic species and 4 prebiotics . It is rational to pursue that it could be effective in preventing postoperative disease . We sought to check weather treatment with Synbiotic 2000 could prevent postoperative recurrence in patients with CD . This was a prospect i ve multicenter , r and omized study . Patients were r and omized to active treatment or placebo in a 2:1 ratio . Follow-up consisted of endoscopic , clinical , and laboratory parameters . Thirty patients were enrolled . No differences were found between the 2 treatment groups regarding gender , age at diagnosis , age at surgery , weight , smoking status , type of disease , length of the resected segment , or medical treatment prior to surgery . No difference in either endoscopic or clinical relapse rate was found between patients treated with once daily dose of Synbiotic 2000 or placebo . In our small study , Synbiotic 2000 had no effect on postoperative recurrence of patients with CD . Larger studies in patients with the inflammatory type of CD undergoing surgery , using higher doses of probiotics cocktail might prove effective Eighty-nine patients who had been treated by ileal resection for Crohn 's disease between 1979 and 1984 were included in a prospect i ve cohort follow up to study the natural course of early postoperative lesions . Recurrent lesions were observed endoscopically in the neoterminal ileum within 1 year of surgery in 73 % of the patients , although only 20 % of the patients had symptoms . Three years after surgery , the endoscopic recurrence rate had increased to 85 % and symptomatic recurrence occurred in 34 % . The ultimate course of the disease was best predicted by the severity of the early postoperative lesions , as observed at ileoscopy . Clinical parameters that influenced outcome were preoperative disease activity , the indication for surgery , and the number of surgical resections . When patients were stratified for preoperative disease activity , the severity of lesions found at endoscopy remained a strong predictive factor for symptomatic recurrence . In 22 other patients su bmi tted to " curative " ileal resection and ileocolonic anastomosis , the segment to be used as neoterminal ileum was carefully examined during surgery , and two large biopsies were taken before making the anastomosis . An ileoscopy was performed 6 months after surgery . Although all patients had a macroscopically normal neoterminal ileum and 19 had entirely normal biopsies at the time of surgery , 21 patients were found at ileoscopy to have developed ileitis involving a 15-cm segment ( range , 4 - 30 cm ) , and 20 had unequivocal microscopic lesions on biopsies . These studies suggest that early lesions in the neoterminal ileum after Crohn 's resection do not originate from microscopic inflammation present in this bowel segment at the time of surgery . The early postoperative lesions in the neoterminal ileum seem to be a suitable model to study the pathogenesis of Crohn 's disease and also to evaluate new therapeutic modalities , either to prevent development of these early lesions or to treat progressive recurrence Background Infliximab is effective treatment for Crohn ’s disease and has been associated with rare , but serious infectious complications . Emerging data suggest a benefit of infliximab in preventing postoperative Crohn ’s disease recurrence . It is not known whether administration of infliximab shortly after resective surgery for Crohn ’s disease increases postoperative complications . Aims To evaluate the risk of developing postoperative complications among Crohn ’s disease patients receiving infliximab within 4 weeks of intestinal resection . Methods As part of a r and omized placebo-controlled infliximab postoperative prevention study , adverse events were prospect ively monitored . Crohn ’s disease patients undergoing intestinal resection were r and omized to placebo or infliximab 2–4 weeks after surgery . Study infusions were administered at 0 , 2 , and 6 weeks then every 8 weeks for 1 year . To evaluate whether infliximab increased postoperative complications , we analyzed all adverse events for 1 year after surgery . Results Twenty-four patients were r and omized to infliximab or placebo after intestinal resection for Crohn ’s disease . Mean time to first postoperative infusion was 20 days ( range 14–25 days ) . Over the course of 1 year , there were 22 total adverse events , but no difference between infliximab and placebo patients ( 12 versus 10 , respectively , P = 1.0 ) . In the immediate postoperative period , within 8 weeks of surgery , the number of adverse events was also similar between the two groups ( 3 infliximab and 5 placebo patients , P = 0.68 ) . There were no serious adverse events and no complications related to wound healing or infection . Conclusions Initiation of infliximab within 4 weeks of intestinal resection was not associated with postoperative complications BACKGROUND & AIMS Prevention of postoperative recurrence after resection for Crohn 's disease ( CD ) would be of great clinical benefit . The efficacy of oral budesonide for prevention of endoscopic recurrence was evaluated in patients undergoing resection for ileal or ileocecal CD . METHODS Sixty-three patients received budesonide and 66 received placebo  in a double-blind , r and omized trial with parallel groups . Ileocolonoscopy , including biopsy , was performed after 3 and 12 months . Indications for surgery were fibrostenosis ( 78 patients ) , disease activity ( 41 ) , and other reasons ( 10 ) . RESULTS The frequency of endoscopic recurrence did not differ between the groups at 3 and 12 months . In patients with disease activity as indication for surgery , the endoscopic recurrence rate at the anastomosis was lower in the budesonide group at 3 months , although not significantly ( 21 % vs. 47 % ; P = 0.11 ) , and at 12 months ( 32 % vs. 65 % ; P = 0.047 ) . There was no such difference with respect to fibrostenosis as indication for surgery . No differences in adverse event patterns were found between the two groups . CONCLUSIONS Oral budesonide , 6 mg daily , offered no benefit in prevention of endoscopic recurrence after surgery for ileal/ileocecal fibrostenotic CD but decreased the recurrence rate in patients who had undergone surgery for disease activity Objective The aim of the study was to compare azathioprine versus mesalazine tablets for the prevention of clinical recurrence in patients with postoperative Crohn 's disease ( CD ) with moderate or severe endoscopic recurrence . Methods This was a 1 year , double-blind , double-dummy , r and omised study which took place in 21 gastroenterology centres in Austria , the Czech Republic , Germany and Israel . The study participants were 78 adults with CD who had undergone resection with ileocolonic anastomosis in the preceding 6–24 months without subsequent clinical recurrence and with a Crohn 's disease activity index ( CDAI ) score < 200 , but with moderate or severe endoscopic recurrence . The study drugs were azathioprine 2.0–2.5 mg/kg/day or mesalazine 4 g/day over 1 year . The primary end point was therapeutic failure during 1 year , defined as a CDAI score ≥200 and an increase of ≥60 points from baseline , or study drug discontinuation due to lack of efficacy or intolerable adverse drug reaction . Results Treatment failure occurred in 22.0 % ( 9/41 ) of azathioprine-treated patients and 10.8 % ( 4/37 ) of mesalazine-treated patients , a difference of 11.1 % ( 95 % CI −5.0 % to 27.3 % , p=0.19 ) . Clinical recurrence was significantly less frequent with azathioprine versus mesalazine ( 0/41 ( 0 % ) vs 4/37 ( 10.8 % ) , p=0.031 ) , whereas study drug discontinuation due to adverse drug reactions only occurred in azathioprine-treated patients ( 9/41 ( 22.0 % ) vs 0 % , p=0.002 ) . The proportion of patients showing ≥1 point reduction in Rutgeerts score between baseline and month 12 was 63.3 % ( 19/30 ) and 34.4 % ( 11/32 ) in the azathioprine and mesalazine groups , respectively ( p=0.023 ) . Conclusions In this population of patients with postoperative CD at high risk of clinical recurrence , superiority for azathioprine versus mesalazine could not be demonstrated for therapeutic failure . Clinical trial registration number NCT00946946 Recurrence rate is high after operation for Crohn 's disease . A multicenter trial was performed to study the effect of radical or nonradical operation and of sulfasalazine prophylaxis versus placebo on postoperative recurrence rate in 232 patients with Crohn 's disease . Sixteen medical and surgical centers participated in the study , 7 operating radically and 9 nonradically . The follow-up period lasted 3 years , the allocation to drug treatment was r and omized and double blind . Recurrence was significantly less frequent and occurred later in patients who were operated nonradically . Patients on sulfasalazine prophylaxis had a better prognosis than on placebo . This effect was statistically significant in the first 2 years of treatment . Both strategies were additive : nonradical operation and sulfasalazine had the best prognosis , radical operation and placebo was worst . It is concluded that postoperative recurrence is best prevented by resecting nonradically and prescribing 3 g of sulfasalazine daily at least over 2 years Summary Background Up to 60 % of patients with Crohn 's disease need intestinal resection within the first 10 years of diagnosis , and postoperative recurrence is common . We investigated whether mercaptopurine can prevent or delay postoperative clinical recurrence of Crohn 's disease . Methods We did a r and omised , placebo-controlled , double-blind trial at 29 UK secondary and tertiary hospitals of patients ( aged > 16 years in Scotl and or > 18 years in Engl and and Wales ) who had a confirmed diagnosis of Crohn 's disease and had undergone intestinal resection . Patients were r and omly assigned ( 1:1 ) by a computer-generated web-based r and omisation system to oral daily mercaptopurine at a dose of 1 mg/kg bodyweight rounded to the nearest 25 mg or placebo ; patients with low thiopurine methyltransferase activity  received half the normal dose . Patients and their carers and physicians were masked to the treatment allocation . Patients were followed up for 3 years . The primary endpoint was clinical recurrence of Crohn 's disease ( Crohn 's Disease Activity Index > 150 plus 100-point increase in score ) and the need for anti-inflammatory rescue treatment or primary surgical intervention . Primary and safety analyses were by intention to treat . Subgroup analyses by smoking status , previous thiopurines , previous infliximab or methotrexate , previous surgery , duration of disease , or age at diagnosis were also done . This trial is registered with the International St and ard R and omised Controlled Trial Register ( IS RCT N89489788 ) and the European Clinical Trials Data base ( EudraCT number 2006 - 005800 - 15 ) . Findings Between June 6 , 2008 , and April 23 , 2012 , 240 patients with Crohn 's disease were r and omly assigned : 128 to mercaptopurine and 112 to placebo . All patients received at least one dose of study drug , and no r and omly assigned patients were excluded from the analysis . 16 ( 13 % ) of patients in the mercaptopurine group versus 26 ( 23 % ) patients in the placebo group had a clinical recurrence of Crohn 's disease and needed anti-inflammatory rescue treatment or primary surgical intervention ( adjusted hazard ratio [ HR ] 0·54 , 95 % CI 0·27–1·06 ; p=0·07 ; unadjusted HR 0·53 , 95 % CI 0·28–0·99 ; p=0·046 ) . In a subgroup analysis , three ( 10 % ) of 29 smokers in the mercaptopurine group and 12 ( 46 % ) of 26 in the placebo group had a clinical recurrence that needed treatment ( HR 0·13 , 95 % CI 0·04–0·46 ) , compared with 13 ( 13 % ) of 99 non-smokers in the mercaptopurine group and 14 ( 16 % ) of 86 in the placebo group ( 0·90 , 0·42–1·94 ; pinteraction=0·018 ) . The effect of mercaptopurine did not significantly differ from placebo for any of the other planned subgroup analyses ( previous thiopurines , previous infliximab or methotrexate , previous surgery , duration of disease , or age at diagnosis ) . The incidence 
    Output:
    
agent
***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: Complications of Crohn ’s disease ( CD ) lead to surgery in about 70–90 % of patients . The majority of patients suffer from relapse of the disease . Colonic bacteria are essential to the development of CD . Therefore , a rationale exists in trying to prevent relapse by manipulation of gut microflora . This is feasible by treatment with probiotics or antibiotics . Synbiotic 2000 is a cocktail containing 4 probiotic species and 4 prebiotics . It is rational to pursue that it could be effective in preventing postoperative disease . We sought to check weather treatment with Synbiotic 2000 could prevent postoperative recurrence in patients with CD . This was a prospect i ve multicenter , r and omized study . Patients were r and omized to active treatment or placebo in a 2:1 ratio . Follow-up consisted of endoscopic , clinical , and laboratory parameters . Thirty patients were enrolled . No differences were found between the 2 treatment groups regarding gender , age at diagnosis , age at surgery , weight , smoking status , type of disease , length of the resected segment , or medical treatment prior to surgery . No difference in either endoscopic or clinical relapse rate was found between patients treated with once daily dose of Synbiotic 2000 or placebo . In our small study , Synbiotic 2000 had no effect on postoperative recurrence of patients with CD . Larger studies in patients with the inflammatory type of CD undergoing surgery , using higher doses of probiotics cocktail might prove effective Eighty-nine patients who had been treated by ileal resection for Crohn 's disease between 1979 and 1984 were included in a prospect i ve cohort follow up to study the natural course of early postoperative lesions . Recurrent lesions were observed endoscopically in the neoterminal ileum within 1 year of surgery in 73 % of the patients , although only 20 % of the patients had symptoms . Three years after surgery , the endoscopic recurrence rate had increased to 85 % and symptomatic recurrence occurred in 34 % . The ultimate course of the disease was best predicted by the severity of the early postoperative lesions , as observed at ileoscopy . Clinical parameters that influenced outcome were preoperative disease activity , the indication for surgery , and the number of surgical resections . When patients were stratified for preoperative disease activity , the severity of lesions found at endoscopy remained a strong predictive factor for symptomatic recurrence . In 22 other patients su bmi tted to " curative " ileal resection and ileocolonic anastomosis , the segment to be used as neoterminal ileum was carefully examined during surgery , and two large biopsies were taken before making the anastomosis . An ileoscopy was performed 6 months after surgery . Although all patients had a macroscopically normal neoterminal ileum and 19 had entirely normal biopsies at the time of surgery , 21 patients were found at ileoscopy to have developed ileitis involving a 15-cm segment ( range , 4 - 30 cm ) , and 20 had unequivocal microscopic lesions on biopsies . These studies suggest that early lesions in the neoterminal ileum after Crohn 's resection do not originate from microscopic inflammation present in this bowel segment at the time of surgery . The early postoperative lesions in the neoterminal ileum seem to be a suitable model to study the pathogenesis of Crohn 's disease and also to evaluate new therapeutic modalities , either to prevent development of these early lesions or to treat progressive recurrence Background Infliximab is effective treatment for Crohn ’s disease and has been associated with rare , but serious infectious complications . Emerging data suggest a benefit of infliximab in preventing postoperative Crohn ’s disease recurrence . It is not known whether administration of infliximab shortly after resective surgery for Crohn ’s disease increases postoperative complications . Aims To evaluate the risk of developing postoperative complications among Crohn ’s disease patients receiving infliximab within 4 weeks of intestinal resection . Methods As part of a r and omized placebo-controlled infliximab postoperative prevention study , adverse events were prospect ively monitored . Crohn ’s disease patients undergoing intestinal resection were r and omized to placebo or infliximab 2–4 weeks after surgery . Study infusions were administered at 0 , 2 , and 6 weeks then every 8 weeks for 1 year . To evaluate whether infliximab increased postoperative complications , we analyzed all adverse events for 1 year after surgery . Results Twenty-four patients were r and omized to infliximab or placebo after intestinal resection for Crohn ’s disease . Mean time to first postoperative infusion was 20 days ( range 14–25 days ) . Over the course of 1 year , there were 22 total adverse events , but no difference between infliximab and placebo patients ( 12 versus 10 , respectively , P = 1.0 ) . In the immediate postoperative period , within 8 weeks of surgery , the number of adverse events was also similar between the two groups ( 3 infliximab and 5 placebo patients , P = 0.68 ) . There were no serious adverse events and no complications related to wound healing or infection . Conclusions Initiation of infliximab within 4 weeks of intestinal resection was not associated with postoperative complications BACKGROUND & AIMS Prevention of postoperative recurrence after resection for Crohn 's disease ( CD ) would be of great clinical benefit . The efficacy of oral budesonide for prevention of endoscopic recurrence was evaluated in patients undergoing resection for ileal or ileocecal CD . METHODS Sixty-three patients received budesonide and 66 received placebo  in a double-blind , r and omized trial with parallel groups . Ileocolonoscopy , including biopsy , was performed after 3 and 12 months . Indications for surgery were fibrostenosis ( 78 patients ) , disease activity ( 41 ) , and other reasons ( 10 ) . RESULTS The frequency of endoscopic recurrence did not differ between the groups at 3 and 12 months . In patients with disease activity as indication for surgery , the endoscopic recurrence rate at the anastomosis was lower in the budesonide group at 3 months , although not significantly ( 21 % vs. 47 % ; P = 0.11 ) , and at 12 months ( 32 % vs. 65 % ; P = 0.047 ) . There was no such difference with respect to fibrostenosis as indication for surgery . No differences in adverse event patterns were found between the two groups . CONCLUSIONS Oral budesonide , 6 mg daily , offered no benefit in prevention of endoscopic recurrence after surgery for ileal/ileocecal fibrostenotic CD but decreased the recurrence rate in patients who had undergone surgery for disease activity Objective The aim of the study was to compare azathioprine versus mesalazine tablets for the prevention of clinical recurrence in patients with postoperative Crohn 's disease ( CD ) with moderate or severe endoscopic recurrence . Methods This was a 1 year , double-blind , double-dummy , r and omised study which took place in 21 gastroenterology centres in Austria , the Czech Republic , Germany and Israel . The study participants were 78 adults with CD who had undergone resection with ileocolonic anastomosis in the preceding 6–24 months without subsequent clinical recurrence and with a Crohn 's disease activity index ( CDAI ) score < 200 , but with moderate or severe endoscopic recurrence . The study drugs were azathioprine 2.0–2.5 mg/kg/day or mesalazine 4 g/day over 1 year . The primary end point was therapeutic failure during 1 year , defined as a CDAI score ≥200 and an increase of ≥60 points from baseline , or study drug discontinuation due to lack of efficacy or intolerable adverse drug reaction . Results Treatment failure occurred in 22.0 % ( 9/41 ) of azathioprine-treated patients and 10.8 % ( 4/37 ) of mesalazine-treated patients , a difference of 11.1 % ( 95 % CI −5.0 % to 27.3 % , p=0.19 ) . Clinical recurrence was significantly less frequent with azathioprine versus mesalazine ( 0/41 ( 0 % ) vs 4/37 ( 10.8 % ) , p=0.031 ) , whereas study drug discontinuation due to adverse drug reactions only occurred in azathioprine-treated patients ( 9/41 ( 22.0 % ) vs 0 % , p=0.002 ) . The proportion of patients showing ≥1 point reduction in Rutgeerts score between baseline and month 12 was 63.3 % ( 19/30 ) and 34.4 % ( 11/32 ) in the azathioprine and mesalazine groups , respectively ( p=0.023 ) . Conclusions In this population of patients with postoperative CD at high risk of clinical recurrence , superiority for azathioprine versus mesalazine could not be demonstrated for therapeutic failure . Clinical trial registration number NCT00946946 Recurrence rate is high after operation for Crohn 's disease . A multicenter trial was performed to study the effect of radical or nonradical operation and of sulfasalazine prophylaxis versus placebo on postoperative recurrence rate in 232 patients with Crohn 's disease . Sixteen medical and surgical centers participated in the study , 7 operating radically and 9 nonradically . The follow-up period lasted 3 years , the allocation to drug treatment was r and omized and double blind . Recurrence was significantly less frequent and occurred later in patients who were operated nonradically . Patients on sulfasalazine prophylaxis had a better prognosis than on placebo . This effect was statistically significant in the first 2 years of treatment . Both strategies were additive : nonradical operation and sulfasalazine had the best prognosis , radical operation and placebo was worst . It is concluded that postoperative recurrence is best prevented by resecting nonradically and prescribing 3 g of sulfasalazine daily at least over 2 years Summary Background Up to 60 % of patients with Crohn 's disease need intestinal resection within the first 10 years of diagnosis , and postoperative recurrence is common . We investigated whether mercaptopurine can prevent or delay postoperative clinical recurrence of Crohn 's disease . Methods We did a r and omised , placebo-controlled , double-blind trial at 29 UK secondary and tertiary hospitals of patients ( aged > 16 years in Scotl and or > 18 years in Engl and and Wales ) who had a confirmed diagnosis of Crohn 's disease and had undergone intestinal resection . Patients were r and omly assigned ( 1:1 ) by a computer-generated web-based r and omisation system to oral daily mercaptopurine at a dose of 1 mg/kg bodyweight rounded to the nearest 25 mg or placebo ; patients with low thiopurine methyltransferase activity  received half the normal dose . Patients and their carers and physicians were masked to the treatment allocation . Patients were followed up for 3 years . The primary endpoint was clinical recurrence of Crohn 's disease ( Crohn 's Disease Activity Index > 150 plus 100-point increase in score ) and the need for anti-inflammatory rescue treatment or primary surgical intervention . Primary and safety analyses were by intention to treat . Subgroup analyses by smoking status , previous thiopurines , previous infliximab or methotrexate , previous surgery , duration of disease , or age at diagnosis were also done . This trial is registered with the International St and ard R and omised Controlled Trial Register ( IS RCT N89489788 ) and the European Clinical Trials Data base ( EudraCT number 2006 - 005800 - 15 ) . Findings Between June 6 , 2008 , and April 23 , 2012 , 240 patients with Crohn 's disease were r and omly assigned : 128 to mercaptopurine and 112 to placebo . All patients received at least one dose of study drug , and no r and omly assigned patients were excluded from the analysis . 16 ( 13 % ) of patients in the mercaptopurine group versus 26 ( 23 % ) patients in the placebo group had a clinical recurrence of Crohn 's disease and needed anti-inflammatory rescue treatment or primary surgical intervention ( adjusted hazard ratio [ HR ] 0·54 , 95 % CI 0·27–1·06 ; p=0·07 ; unadjusted HR 0·53 , 95 % CI 0·28–0·99 ; p=0·046 ) . In a subgroup analysis , three ( 10 % ) of 29 smokers in the mercaptopurine group and 12 ( 46 % ) of 26 in the placebo group had a clinical recurrence that needed treatment ( HR 0·13 , 95 % CI 0·04–0·46 ) , compared with 13 ( 13 % ) of 99 non-smokers in the mercaptopurine group and 14 ( 16 % ) of 86 in the placebo group ( 0·90 , 0·42–1·94 ; pinteraction=0·018 ) . The effect of mercaptopurine did not significantly differ from placebo for any of the other planned subgroup analyses ( previous thiopurines , previous infliximab or methotrexate , previous surgery , duration of disease , or age at diagnosis ) . The incidence 
    Output:
    