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: BACKGROUND Enteral feeding with either elemental or polymeric diets is an established primary therapy for active Crohn 's disease . However , the role of supplementing normal food with elemental diet in the long-term management of Crohn 's disease has hitherto not been explored . PATIENTS AND METHODS A series of 39 consecutive patients with Crohn 's disease in clinical remission were studied . Of these , 21 patients ( Group 1 ) received oral nutritional supplementation , taken in addition to their normal diet . Their outcome ( relapse rate , Crohn 's disease activity index , inflammatory markers ) was compared with that of 18 patients ( Group 2 ) , who were maintained on a normal unrestricted diet over an observation period of 12 months . RESULTS A total of 17 patients ( 81 % ) tolerated the nutritional supplementation . On an intention-to-treat basis , 10 patients ( 48 % ) remained in remission for 12 months , compared to 4/18 ( 22 % ) patients in Group 2 , p<0.0003 . Their Crohn 's disease activity index and CRP remained stable while their weight and body mass index improved during the period of nutrition therapy Seven patients in Group 1 and 14 in Group 2 relapsed at a mean of 7.4+/-0.9 and 6.2+/-0.4 months , respectively . The response to nutrition supplement was independent of age , sex , disease duration or location . Four patients ( 19 % ) were intolerant to enteral feeding . CONCLUSIONS Nutritional supplementation is safe , well tolerated and effective in the long-term management of patients with quiescent Crohn 's disease Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research , derived from extensive review of published literature . When data that will withst and objective scrutiny are not available , a recommendation may be made based on a consensus of experts . Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty . Guidelines are intended to be flexible , not necessarily indicating the only acceptable approach , and should be distinguished from st and ards of care that are inflexible and rarely violated . Given the wide range of choices in any health-care problem , the physician should select the course best suited to the individual patient and the clinical situation presented . These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee . Expert opinion is solicited from the outset for the document . The quality of evidence upon which a specific recommendation is based is as follows : Grade A : Homogeneous evidence from multiple well- design ed r and omized ( therapeutic ) or cohort ( descriptive ) controlled trials , each involving a number of participants to be of sufficient statistical power . Grade B : Evidence from at least one large well- design ed clinical trial with or without r and omization , from cohort or case – control analytic studies , or well- design ed meta- analysis . Grade C : Evidence based on clinical experience , descriptive studies , or reports of expert committees . The Committee review s guidelines in depth , with participation from experienced clinicians and others in related fields . The final recommendations are based on the data available at the time of the production of the document and may be up date d with pertinent scientific developments at a later time BACKGROUND Nutritional therapy plays an important role in the management of Crohn disease , particularly during the acute phase . Nutritional supplementation may also prevent relapses during the quiescent phase of Crohn disease , though this aspect has not been widely explored . METHODS Thirty-three patients with Crohn disease in remission were studied . All had steroid-dependent disease . Patients were r and omized to receive either elemental diet ( n = 19 , EO28 Extra ) or polymeric diet ( Forticips , n = 14 ) . The supplement was given orally in addition to normal food in an amount to provide 35%-50 % of pre-trial total calorie intake . Prednisolone was withdrawn gradually . Patients were followed up for 12 months . Failure was defined as increase in CDAI by 100 points from baseline to > 200 , inability to withdraw chronic steroid therapy completely , need for surgery or steroid therapy . RESULTS The nutritional supplement was successful in 14 ( 43 % ) patients who remained in remission for 12 months with complete withdrawal of steroids . The response to elemental diet ( 42 % ) was similar to that of polymeric diet ( 43 % ) . Nutrition supplement  failed in 13 ( 39 % ) . Six ( 18 % ) patients were intolerant to enteral feeding because of smell and taste problems . Per- protocol analysis of data indicated that the success rate of nutrition supplement  in steroid-dependent patients was 52 % ( 14 out of 27 patients ) . No disease or patient-related factors helped predict the response to nutrition supplement . CONCLUSION Nutritional supplementation with either an elemental or polymeric diet may provide a safe and effective alternative to chronic steroid therapy in patients with steroid-dependent Crohn disease BACKGROUND 6-Mercaptopurine is often used as maintenance therapy in patients with Crohn 's disease . However , toxicities like myelosuppression limit its clinical benefit . AIMS To evaluate the efficacy of elemental diet versus 6-mercaptopurine as maintenance therapy in Crohn 's disease . METHODS Ninety-five eligible patients with Crohn 's disease activity index ≤150 were r and omly assigned to : 6-mercaptopurine ( 0.5 - 1.5mg/kg/day , n=30 ) ; Elental as an elemental diet ( ≥900 kcal/day , n=32 ) ; none ( control , n=33 ) . In the three groups , patients were and remained on 5-aminosalicylic acid ( 2250 - 3000 mg/day ) . Patients were observed for 2 years and the rate of relapse ( Crohn 's disease activity index ≥200 ) was monitored . RESULTS At 24 months , the fractions of patients who had maintained remission were 60 % , 46.9 % and 27.2 % for 6-mercaptopurine , Elental and the control groups , respectively . Log-rank test showed better efficacy  for 6-mercaptopurine ( P=0.0041 ) and Elental ( P=0.0348 ) versus control . No significant difference was found between 6-mercaptopurine  and Elental . Further , in the 6-mercaptopurine group , 2 patients experienced liver injury and one developed alopecia . CONCLUSIONS This 24 months comparison study showed that Elental as maintenance therapy in Crohn 's disease patients was as effective as 6-mercaptopurine . Elental should be useful for long-term maintenance therapy in Crohn 's disease . This is the first comparison study evaluating nutritional therapy versus 6-mercaptopurine Since specific treatment has not yet been decided on for Crohn 's disease , the immediate target is the induction of remission and its maintenance . We examined the effects of an elemental diet ( ED ) in Crohn 's disease with special reference to the maintenance of remission . Eighty-four patients received total enteral nutrition with the ED ( 35 to 40 kcal/kg ideal body weight/day ) and /or conventional drug treatment for induction of remission . Sixty-one patients in remission were then followed-up with prolonged ED therapy ( home elemental enteral hyperalimentation , HEEH ) and /or drugs . During the follow-up periods the course of patients receiving HEEH was better than those of patients without HEEH , namely the cumulative continuous remission rates after one , 2 and 4 years were , 94 % , 63 % and 63 % in the group receiving HEEH , 75 % , 66 % and 66 % in the group receiving HEEH and drugs , 63 % , 42 % and 0 % in the group receiving drugs , and 50 % , 33 % and 0 % in the group receiving no maintenance therapy , respectively . In particular , when more than 30 kcal/kg ideal body weight/day of the ED was given , the maintenance of remission was successful in 95 % of the patients . These results indicated that ED therapy was effective not only for the induction of remission but also for the maintenance of remission in Crohn 's disease Purpose The aim of this study was to investigate the long-term effect of enteral nutrition ( EN ) as a maintenance therapy in Crohn ’s disease ( CD ) patients following surgery . Methods This study was an extension of our previous study to prolong the duration of intervention and follow-up from 1 to 5 years . Forty consecutive patients who underwent resection for ileal or ileocolic CD were included . Following surgery , 20 patients received continuous elemental diet infusion during the nighttime plus a low-fat diet during the daytime ( EN group ) . Another 20 patients received neither nutritional therapy nor food restriction ( control group ) . All patients were followed for 5 years after operation . No patient received corticosteroid , immunosuppressants , or infliximab except patients who developed recurrence . The end point of this study was recurrence requiring biologic therapy or reoperation . Recurrence rates were analyzed on an intention-to-treat basis . Results In the EN group , four patients could not continue tube intubation for elemental diet intake . Two patients ( 10 % ) in the EN group and nine patients ( 45 % ) in the control group developed recurrence requiring infliximab therapy ( P = 0.03 ) . The cumulative recurrence incidence rate requiring infliximab was significantly lower in the EN group vs the control group ( P = 0.02 ) . One patient ( 5 % ) in the EN group and five patients ( 25 % ) in the control group required reoperation for recurrence ( P = 0.18 ) . The cumulative incidence of reoperation was lower in the EN group vs the control group , the difference not being significant ( P = 0.08 ) . Conclusion The outcomes of this study suggest that EN therapy reduces the incidence of postoperative CD recurrence The impact of enteral nutrition on post‐operative recurrence has not been properly examined Background : Long‐term enteral nutrition may maintain clinical and endoscopic remission in patients with Crohn 's disease ( CD ) . The aim of this prospect i ve study was to investigate the impacts of long‐term enteral nutrition on clinical and endoscopic disease activities and mucosal tissue cytokines in patients with quiescent CD . Methods : Forty patients with CD who achieved clinical remission were included . Of these , 20 received continuous elemental diet ( Elental ) infusion during the nighttime and a low‐fat diet during the daytime ( EN group ) and 20 received neither nutritional therapy nor food restriction ( non‐EN group ) . With these regimens , all 40 patients were monitored for 1 year . Further , ileocolonoscopy was performed at entry , at 6 and 12 months , and mucosal biopsies were taken for cytokine assays . Results : On an intention‐to‐treat basis , 5 patients ( 25 % ) in the EN group and 13 ( 65 % ) in the non‐EN group had a clinical relapse during the 1‐year observation ( P = 0.03 ) . The mean endoscopic inflammation ( EI ) scores were not significantly different between the groups at both entry and 6 months , but at 12 months EI scores were significantly higher in the non‐EN group than in the EN group ( P = 0.04 ) . Additionally , the mucosal tissue interleukin (IL)‐1&bgr ; , IL‐6 , and tumor necrosis factor (TNF)‐&agr ; levels significantly increased with time in the non‐EN group ( entry versus 12 months , IL‐1&bgr ; , P = 0.02 ; IL‐6 , P = 0.002 ; TNF‐&agr ; , P = 0.001 ) . In the EN group these cytokines did not show a significant increase . Conclusions : Long‐term enteral nutrition in patients with quiescent CD has a clear suppressive effect on clinical and endoscopic disease activities and the mucosal inflammatory cytokine levels . ( Inflamm Bowel Dis 2007 Purpose Hitherto , the efficacy of enteral nutrition ( EN ) on clinical outcomes during biological maintenance therapy in Crohn ’s disease ( CD ) has not been investigated . This prospect i ve study was to assess the efficacy of EN on the maintenance rate of clinical remission in patients with quiescent CD receiving infliximab as maintenance therapy . Methods Fifty-six patients who achieved clinical remission with infliximab induction therapy received infliximab as maintenance therapy ( 5 mg/kg , every 8 weeks ) . Thirty-two of the 56 patients received concomitant EN : elemental diet infusion during night-time and a low fat diet during daytime ( EN group ) , while the remaining 24 patients received neither nutritional therapy nor food restriction ( non-EN group ) . All patients were followed for 56 weeks ; CD activity index ( CDAI ) was assessed and CDAI < 150 was defined as clinical remission . Results During the 56-week observation , the mean CDAI was not significantly different between the 2 groups . Seven patients in the EN group ceased EN therapy because they maintained complete remission . On an intention-to-treat basis , 25 patients in the EN group ( 78 % ) and 16 patients in the non-EN group ( 67 % ) remained in clinical remission during the 56-week observation ( P = 0.51 ) . Conclusions The outcomes of this prospect i ve study 
    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: BACKGROUND Enteral feeding with either elemental or polymeric diets is an established primary therapy for active Crohn 's disease . However , the role of supplementing normal food with elemental diet in the long-term management of Crohn 's disease has hitherto not been explored . PATIENTS AND METHODS A series of 39 consecutive patients with Crohn 's disease in clinical remission were studied . Of these , 21 patients ( Group 1 ) received oral nutritional supplementation , taken in addition to their normal diet . Their outcome ( relapse rate , Crohn 's disease activity index , inflammatory markers ) was compared with that of 18 patients ( Group 2 ) , who were maintained on a normal unrestricted diet over an observation period of 12 months . RESULTS A total of 17 patients ( 81 % ) tolerated the nutritional supplementation . On an intention-to-treat basis , 10 patients ( 48 % ) remained in remission for 12 months , compared to 4/18 ( 22 % ) patients in Group 2 , p<0.0003 . Their Crohn 's disease activity index and CRP remained stable while their weight and body mass index improved during the period of nutrition therapy Seven patients in Group 1 and 14 in Group 2 relapsed at a mean of 7.4+/-0.9 and 6.2+/-0.4 months , respectively . The response to nutrition supplement was independent of age , sex , disease duration or location . Four patients ( 19 % ) were intolerant to enteral feeding . CONCLUSIONS Nutritional supplementation is safe , well tolerated and effective in the long-term management of patients with quiescent Crohn 's disease Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research , derived from extensive review of published literature . When data that will withst and objective scrutiny are not available , a recommendation may be made based on a consensus of experts . Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty . Guidelines are intended to be flexible , not necessarily indicating the only acceptable approach , and should be distinguished from st and ards of care that are inflexible and rarely violated . Given the wide range of choices in any health-care problem , the physician should select the course best suited to the individual patient and the clinical situation presented . These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee . Expert opinion is solicited from the outset for the document . The quality of evidence upon which a specific recommendation is based is as follows : Grade A : Homogeneous evidence from multiple well- design ed r and omized ( therapeutic ) or cohort ( descriptive ) controlled trials , each involving a number of participants to be of sufficient statistical power . Grade B : Evidence from at least one large well- design ed clinical trial with or without r and omization , from cohort or case – control analytic studies , or well- design ed meta- analysis . Grade C : Evidence based on clinical experience , descriptive studies , or reports of expert committees . The Committee review s guidelines in depth , with participation from experienced clinicians and others in related fields . The final recommendations are based on the data available at the time of the production of the document and may be up date d with pertinent scientific developments at a later time BACKGROUND Nutritional therapy plays an important role in the management of Crohn disease , particularly during the acute phase . Nutritional supplementation may also prevent relapses during the quiescent phase of Crohn disease , though this aspect has not been widely explored . METHODS Thirty-three patients with Crohn disease in remission were studied . All had steroid-dependent disease . Patients were r and omized to receive either elemental diet ( n = 19 , EO28 Extra ) or polymeric diet ( Forticips , n = 14 ) . The supplement was given orally in addition to normal food in an amount to provide 35%-50 % of pre-trial total calorie intake . Prednisolone was withdrawn gradually . Patients were followed up for 12 months . Failure was defined as increase in CDAI by 100 points from baseline to > 200 , inability to withdraw chronic steroid therapy completely , need for surgery or steroid therapy . RESULTS The nutritional supplement was successful in 14 ( 43 % ) patients who remained in remission for 12 months with complete withdrawal of steroids . The response to elemental diet ( 42 % ) was similar to that of polymeric diet ( 43 % ) . Nutrition supplement  failed in 13 ( 39 % ) . Six ( 18 % ) patients were intolerant to enteral feeding because of smell and taste problems . Per- protocol analysis of data indicated that the success rate of nutrition supplement  in steroid-dependent patients was 52 % ( 14 out of 27 patients ) . No disease or patient-related factors helped predict the response to nutrition supplement . CONCLUSION Nutritional supplementation with either an elemental or polymeric diet may provide a safe and effective alternative to chronic steroid therapy in patients with steroid-dependent Crohn disease BACKGROUND 6-Mercaptopurine is often used as maintenance therapy in patients with Crohn 's disease . However , toxicities like myelosuppression limit its clinical benefit . AIMS To evaluate the efficacy of elemental diet versus 6-mercaptopurine as maintenance therapy in Crohn 's disease . METHODS Ninety-five eligible patients with Crohn 's disease activity index ≤150 were r and omly assigned to : 6-mercaptopurine ( 0.5 - 1.5mg/kg/day , n=30 ) ; Elental as an elemental diet ( ≥900 kcal/day , n=32 ) ; none ( control , n=33 ) . In the three groups , patients were and remained on 5-aminosalicylic acid ( 2250 - 3000 mg/day ) . Patients were observed for 2 years and the rate of relapse ( Crohn 's disease activity index ≥200 ) was monitored . RESULTS At 24 months , the fractions of patients who had maintained remission were 60 % , 46.9 % and 27.2 % for 6-mercaptopurine , Elental and the control groups , respectively . Log-rank test showed better efficacy  for 6-mercaptopurine ( P=0.0041 ) and Elental ( P=0.0348 ) versus control . No significant difference was found between 6-mercaptopurine  and Elental . Further , in the 6-mercaptopurine group , 2 patients experienced liver injury and one developed alopecia . CONCLUSIONS This 24 months comparison study showed that Elental as maintenance therapy in Crohn 's disease patients was as effective as 6-mercaptopurine . Elental should be useful for long-term maintenance therapy in Crohn 's disease . This is the first comparison study evaluating nutritional therapy versus 6-mercaptopurine Since specific treatment has not yet been decided on for Crohn 's disease , the immediate target is the induction of remission and its maintenance . We examined the effects of an elemental diet ( ED ) in Crohn 's disease with special reference to the maintenance of remission . Eighty-four patients received total enteral nutrition with the ED ( 35 to 40 kcal/kg ideal body weight/day ) and /or conventional drug treatment for induction of remission . Sixty-one patients in remission were then followed-up with prolonged ED therapy ( home elemental enteral hyperalimentation , HEEH ) and /or drugs . During the follow-up periods the course of patients receiving HEEH was better than those of patients without HEEH , namely the cumulative continuous remission rates after one , 2 and 4 years were , 94 % , 63 % and 63 % in the group receiving HEEH , 75 % , 66 % and 66 % in the group receiving HEEH and drugs , 63 % , 42 % and 0 % in the group receiving drugs , and 50 % , 33 % and 0 % in the group receiving no maintenance therapy , respectively . In particular , when more than 30 kcal/kg ideal body weight/day of the ED was given , the maintenance of remission was successful in 95 % of the patients . These results indicated that ED therapy was effective not only for the induction of remission but also for the maintenance of remission in Crohn 's disease Purpose The aim of this study was to investigate the long-term effect of enteral nutrition ( EN ) as a maintenance therapy in Crohn ’s disease ( CD ) patients following surgery . Methods This study was an extension of our previous study to prolong the duration of intervention and follow-up from 1 to 5 years . Forty consecutive patients who underwent resection for ileal or ileocolic CD were included . Following surgery , 20 patients received continuous elemental diet infusion during the nighttime plus a low-fat diet during the daytime ( EN group ) . Another 20 patients received neither nutritional therapy nor food restriction ( control group ) . All patients were followed for 5 years after operation . No patient received corticosteroid , immunosuppressants , or infliximab except patients who developed recurrence . The end point of this study was recurrence requiring biologic therapy or reoperation . Recurrence rates were analyzed on an intention-to-treat basis . Results In the EN group , four patients could not continue tube intubation for elemental diet intake . Two patients ( 10 % ) in the EN group and nine patients ( 45 % ) in the control group developed recurrence requiring infliximab therapy ( P = 0.03 ) . The cumulative recurrence incidence rate requiring infliximab was significantly lower in the EN group vs the control group ( P = 0.02 ) . One patient ( 5 % ) in the EN group and five patients ( 25 % ) in the control group required reoperation for recurrence ( P = 0.18 ) . The cumulative incidence of reoperation was lower in the EN group vs the control group , the difference not being significant ( P = 0.08 ) . Conclusion The outcomes of this study suggest that EN therapy reduces the incidence of postoperative CD recurrence The impact of enteral nutrition on post‐operative recurrence has not been properly examined Background : Long‐term enteral nutrition may maintain clinical and endoscopic remission in patients with Crohn 's disease ( CD ) . The aim of this prospect i ve study was to investigate the impacts of long‐term enteral nutrition on clinical and endoscopic disease activities and mucosal tissue cytokines in patients with quiescent CD . Methods : Forty patients with CD who achieved clinical remission were included . Of these , 20 received continuous elemental diet ( Elental ) infusion during the nighttime and a low‐fat diet during the daytime ( EN group ) and 20 received neither nutritional therapy nor food restriction ( non‐EN group ) . With these regimens , all 40 patients were monitored for 1 year . Further , ileocolonoscopy was performed at entry , at 6 and 12 months , and mucosal biopsies were taken for cytokine assays . Results : On an intention‐to‐treat basis , 5 patients ( 25 % ) in the EN group and 13 ( 65 % ) in the non‐EN group had a clinical relapse during the 1‐year observation ( P = 0.03 ) . The mean endoscopic inflammation ( EI ) scores were not significantly different between the groups at both entry and 6 months , but at 12 months EI scores were significantly higher in the non‐EN group than in the EN group ( P = 0.04 ) . Additionally , the mucosal tissue interleukin (IL)‐1&bgr ; , IL‐6 , and tumor necrosis factor (TNF)‐&agr ; levels significantly increased with time in the non‐EN group ( entry versus 12 months , IL‐1&bgr ; , P = 0.02 ; IL‐6 , P = 0.002 ; TNF‐&agr ; , P = 0.001 ) . In the EN group these cytokines did not show a significant increase . Conclusions : Long‐term enteral nutrition in patients with quiescent CD has a clear suppressive effect on clinical and endoscopic disease activities and the mucosal inflammatory cytokine levels . ( Inflamm Bowel Dis 2007 Purpose Hitherto , the efficacy of enteral nutrition ( EN ) on clinical outcomes during biological maintenance therapy in Crohn ’s disease ( CD ) has not been investigated . This prospect i ve study was to assess the efficacy of EN on the maintenance rate of clinical remission in patients with quiescent CD receiving infliximab as maintenance therapy . Methods Fifty-six patients who achieved clinical remission with infliximab induction therapy received infliximab as maintenance therapy ( 5 mg/kg , every 8 weeks ) . Thirty-two of the 56 patients received concomitant EN : elemental diet infusion during night-time and a low fat diet during daytime ( EN group ) , while the remaining 24 patients received neither nutritional therapy nor food restriction ( non-EN group ) . All patients were followed for 56 weeks ; CD activity index ( CDAI ) was assessed and CDAI < 150 was defined as clinical remission . Results During the 56-week observation , the mean CDAI was not significantly different between the 2 groups . Seven patients in the EN group ceased EN therapy because they maintained complete remission . On an intention-to-treat basis , 25 patients in the EN group ( 78 % ) and 16 patients in the non-EN group ( 67 % ) remained in clinical remission during the 56-week observation ( P = 0.51 ) . Conclusions The outcomes of this prospect i ve study 
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