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 In a controlled study patients with Crohn 's disease received an exclusion diet or an diet low in refined carbohydrates and rich in fiber .  A total of 26 patients was observed for 1 year . The exclusion diet was not significantly superior to the st and ard diet with respect to the clinical course ( Crohn 's disease activity index according to Best or van Hees ) or laboratory parameters of inflammatory activity . During dietary counselling relapses were infrequent and symptoms improved in both dietary groups Background . Germinated barley foodstuff ( GBF ) is a prebiotic foodstuff that effectively increases luminal butyrate production by stimulating the growth of protective bacteria . In the first pilot study , GBF has been shown to reduce both clinical activity and mucosal inflammation in ulcerative colitis ( UC ) . The aim of this study was to investigate the efficacy of GBF in the treatment of UC in a multicenter open control trial . Methods . Eighteen patients with mildly to moderately active UC were divided into two groups using a r and om allocation protocol . The control group ( n = 7 ) were given a baseline anti-inflammatory therapy for 4 weeks . In the GBF-treated group ( n = 11 ) , patients received 20–30 g GBF daily , together with the baseline treatment , for 4 weeks . The response to the treatments was evaluated clinical ly and endoscopically . Fecal micro-flora were also analyzed . Results . After 4 weeks of observation , the GBF-treated group showed a significant decrease in clinical activity index scores compared with the control group ( P < 0.05 ) . No side effects related to GBF were observed . GBF therapy increased fecal concentrations of Bifidobacterium and Eubacterium limosum . Conclusions . Oral GBF therapy may have the potency to reduce clinical activity of UC . We believe that these results support the use of GBF administration as a new adjunct therapy for UC Crohn 's disease involves different gastrointestinal sites and may be characterized by high rates of strictures and penetrating complications . The present study applied the newly described Montreal schema of classification to a large , prospect ively accumulated clinical data base . In addition , age dependence was evaluated at diagnosis , with regard to disease location and disease behaviour . There were 1015 consecutively evaluated patients ( 449 male and 566 female ) . Disease was most often localized in the ileocolon and was usually complex with stricture formation or penetrating complications . For both sexes , with increasing age at diagnosis , Crohn 's disease was less extensive , more often localized in the colon alone and characterized by less complex disease behaviour , especially with less penetrating disease complications . Using the Montreal classification for Crohn 's disease , these results define the clinical features in a large , single clinician data base and demonstrate age dependence in the phenotypic clinical expression of Crohn 's disease Systematic review s ( SRs ) are an increasingly popular evidence -based tool and are often used to answer complex research questions across many different research domains . Early SR methodology was advanced by social scientists , and the term meta- analysis was coined by a social scientist who also conducted research in psychology . SRs have recently become popular in healthcare and are likely to be beneficial in any field . The aim of this report is to highlight issues in SR conduct with a focus on the field of nutrition and to make recommendations on improving SR conduct in this area . Development of the research question is probably the most important step in conducting an SR . The 4 main components of an answerable question are 1 ) the patient , population , or problem ; 2 ) the intervention , independent variable , or exposure ; 3 ) the comparators ; and 4 ) the dependent variables or outcomes of interest . The question will be used to determine the optimal methods for conducting the SR . SRs often include study design s beyond r and omized trials and do not always include a meta- analysis of the results . Other topics explored include underst and ing and interpreting discordant review s and the importance of reporting tools [ eg , QUality Of Reporting Of Meta-analyses ( QUOROM Statement ) or CONsoli date d St and ards Of Reporting of Trials ( CONSORT Statement ) ] . Recommendations are then provided , such as developing a capacity-building program , search ing the primary literature for research gaps , and extending reporting tools such as the QUOROM Statement to the field of nutrition Background and aims : Ulcerative colitis ( UC ) is an acute and chronic inflammatory disease of the large bowel with unknown aetiology . The immune response against normal commensal microorganisms is believed to drive inflammatory processes associated with UC . Therefore , modulation of bacterial communities on the gut mucosa , through the use of probiotics and prebiotics , may be used to modify the disease state . Methods : A synbiotic was developed for use in UC patients combining a probiotic , Bifidobacterium longum , isolated from healthy rectal epithelium , and a prebiotic ( Synergy 1 ) , a preferential inulin-oligofructose growth substrate for the probiotic strain . Treatment was employed in a double blinded r and omised controlled trial using 18 patients with active UC for a period of one month . Clinical status was scored and rectal biopsies were collected before and after treatment , and transcription levels of epithelium related immune markers were measured . Results : Sigmoidoscopy scores ( scale 0–6 ) were reduced in the test group ( start 4.5 ( 1.4 ) , end 3.1 ( 2.5 ) ) compared with placebo ( start 2.6 ( 2.1 ) , end 3.2 ( 2.2 ) ) ( p = 0.06 ) . mRNA levels for human beta defensins 2 , 3 , and 4 , which are strongly upregulated in active UC , were significantly reduced in the test group after treatment ( p = 0.016 , 0.038 , and 0.008 , respectively ) . Tumour necrosis factor α and interleukin 1α , which are inflammatory cytokines that drive inflammation and induce defensin expression , were also significantly reduced after treatment ( p = 0.018 and 0.023 , respectively ) . Biopsies in the test group had reduced inflammation and regeneration of epithelial tissue . Conclusions : Short term synbiotic treatment of active UC result ed in improvement of the full clinical appearance of chronic inflammation in patients receiving this therapy Abstract PURPOSE : Inflammation is a constant finding in the ileal reservoir of patients with an ileal pouch-anal anastomosis and is associated with decreased fecal concentrations of the short chain fatty acid butyrate , increased fecal pH , changes in fecal flora , and increased concentrations of secondary bile acids . In healthy subjects , inulin , a dietary fiber , is fermented to short chain fatty acids and leads to a lower pH and potentially beneficial changes in fecal flora . The aim of the present study was to investigate the effect of enteral supplementation of inulin on inflammation of the ileal reservoir . METHODS : Twenty patients received 24 g of inulin or placebo daily during three weeks in a r and omized , double-blind , crossover design . Stools were analyzed after each test period for pH , short chain fatty acids , microflora , and bile acids . Inflammation was assessed endoscopically , histologically , and clinical ly . RESULTS : Compared with placebo , three weeks of dietary supplementation with 24 g of inulin increased butyrate concentrations , lowered pH , decreased numbers of Bacteroides fragilis , and diminished concentrations of secondary bile acids in feces . This was endoscopically and histologically accompanied by a reduction of inflammation of the mucosa of the ileal reservoir . CONCLUSION : Enteral inulin supplementation leads to a decrease of inflammation-associated factors and to a reduction of inflammation of pouch mucosa Between 1 September 1980 and 31 August 1983 , 352 patients with inactive or mildly active Crohn 's disease but not taking drug treatment apart from sulphasalazine were entered from 40 hospitals into a prospect i ve trial to assess the effects of two different diets on disease activity over two years . One hundred and sixty two patients were r and omly allocated to take a diet unrestricted in sugar and low in fibre and 190 to a diet with little or no sugar and high in unrefined carbohydrate .  No clear difference in clinical course was detected among patients who accepted the two different types of dietary advice Twenty patients with ulcerative colitis in remission were asked to eat a high-fibre diet including 25 g bran daily and , if possible , to discontinue maintenance therapy with sulphasalazine . Only five patients ( 25 per cent ) were able to do this and remained in remission for six months . In contrast , of 15 patients asked to continue susphasalazine and their normal diet 12 ( 80 per cent ) remained in remission . A high-fibre diet is unable to replace sulphasalazine as maintenance treatment of ulcerative colitis in remission Germinated barley foodstuff ( GBF ) is a prebiotic which increases luminal butyrate production by modulating the microfloral distribution . GBF has been shown to reduce both clinical activity and mucosal damage in active ulcerative colitis ( UC ) with mild to moderate activity . However , the efficacy of GBF in patients with UC during the remission stage is unknown . The aim of this study was to investigate the efficacy of GBF as a maintenance therapy in patients with UC while in remission . Fifty-nine patients with UC in remission according to Rachmilewitz 's clinical activity index ( CAI ) score of < /=4 were enrolled and divided into two groups , control ( n=37 ) and GBF ( n=22 ) . Patients in the control group were given conventional treatment alone for 12 months , while patients in the GBF group received conventional therapy plus 20 g of GBF daily . The response to treatments was assessed by monitoring the CAI and endoscopic score according to Matts . Significantly better CAI values were seen in the GBF group at 3 , 6 , and 12 months compared with the values in the control group . The cumulative recurrence rate in the GBF group with steroid tapering treatment was significantly lower compared with the value in the control group . No side effects related to GBF were observed . GBF appeared to be effective and safe as a maintenance therapy to taper steroid dose and prolong remission in patients with UC 20 patients with Crohn 's disease took part in a controlled trial in which remission was maintained by either an unrefined carbohydrate fibre rich diet or a diet which excluded specific foods to which a patient was intolerant . 7 out of the 10 patients on the exclusion diet remained in remission for 6 months compared with none out of the 10 on an unrefined carbohydrate fibre rich diet ( p less than 0.05 , Fisher 's exact test ) . In an uncontrolled study an exclusion diet allowed 51 out of 77 patients to remain well on the diet alone for periods of up to 51 months , and with an average annual relapse rate of less than 10 % Seventy patients with non-stenosing Crohn 's disease were r and omly assigned to follow a low residue diet or a normal Italian diet for a mean of 29 months . The two groups were comparable at the onset in various measures of disease severity and diet . Patients complied well with the diet prescriptions , the low residue group eating a mean of 8.1 portions a week of fibre containing foods and the liberalized group a mean of 26.6 portions ( p less than 0.005 ) . There was no difference in outcome between the two groups , including symptoms , need for hospitalisation , need for surgery , new complications , nutritional status , or postoperative recurrence . Eighty six per cent of patients eating ad libitum and 65 % of patients who avoided roughage eliminated one or more permitted foods because of subjective intolerance . Lifting of dietary restrictions , which results in a more appetizing and nutritious diet , does not cause symptomatic deterioration or precipitate intestinal obstruction in Crohn 's disease OBJECTIVE Butyrate enemas may be effective in the treatment of active distal ulcerative colitis . Because colonic fermentation of Plantago ovata seeds ( dietary fiber ) yields butyrate , the aim of this study was to assess the efficacy and safety of Plantago ovata seeds 
    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 In a controlled study patients with Crohn 's disease received an exclusion diet or an diet low in refined carbohydrates and rich in fiber .  A total of 26 patients was observed for 1 year . The exclusion diet was not significantly superior to the st and ard diet with respect to the clinical course ( Crohn 's disease activity index according to Best or van Hees ) or laboratory parameters of inflammatory activity . During dietary counselling relapses were infrequent and symptoms improved in both dietary groups Background . Germinated barley foodstuff ( GBF ) is a prebiotic foodstuff that effectively increases luminal butyrate production by stimulating the growth of protective bacteria . In the first pilot study , GBF has been shown to reduce both clinical activity and mucosal inflammation in ulcerative colitis ( UC ) . The aim of this study was to investigate the efficacy of GBF in the treatment of UC in a multicenter open control trial . Methods . Eighteen patients with mildly to moderately active UC were divided into two groups using a r and om allocation protocol . The control group ( n = 7 ) were given a baseline anti-inflammatory therapy for 4 weeks . In the GBF-treated group ( n = 11 ) , patients received 20–30 g GBF daily , together with the baseline treatment , for 4 weeks . The response to the treatments was evaluated clinical ly and endoscopically . Fecal micro-flora were also analyzed . Results . After 4 weeks of observation , the GBF-treated group showed a significant decrease in clinical activity index scores compared with the control group ( P < 0.05 ) . No side effects related to GBF were observed . GBF therapy increased fecal concentrations of Bifidobacterium and Eubacterium limosum . Conclusions . Oral GBF therapy may have the potency to reduce clinical activity of UC . We believe that these results support the use of GBF administration as a new adjunct therapy for UC Crohn 's disease involves different gastrointestinal sites and may be characterized by high rates of strictures and penetrating complications . The present study applied the newly described Montreal schema of classification to a large , prospect ively accumulated clinical data base . In addition , age dependence was evaluated at diagnosis , with regard to disease location and disease behaviour . There were 1015 consecutively evaluated patients ( 449 male and 566 female ) . Disease was most often localized in the ileocolon and was usually complex with stricture formation or penetrating complications . For both sexes , with increasing age at diagnosis , Crohn 's disease was less extensive , more often localized in the colon alone and characterized by less complex disease behaviour , especially with less penetrating disease complications . Using the Montreal classification for Crohn 's disease , these results define the clinical features in a large , single clinician data base and demonstrate age dependence in the phenotypic clinical expression of Crohn 's disease Systematic review s ( SRs ) are an increasingly popular evidence -based tool and are often used to answer complex research questions across many different research domains . Early SR methodology was advanced by social scientists , and the term meta- analysis was coined by a social scientist who also conducted research in psychology . SRs have recently become popular in healthcare and are likely to be beneficial in any field . The aim of this report is to highlight issues in SR conduct with a focus on the field of nutrition and to make recommendations on improving SR conduct in this area . Development of the research question is probably the most important step in conducting an SR . The 4 main components of an answerable question are 1 ) the patient , population , or problem ; 2 ) the intervention , independent variable , or exposure ; 3 ) the comparators ; and 4 ) the dependent variables or outcomes of interest . The question will be used to determine the optimal methods for conducting the SR . SRs often include study design s beyond r and omized trials and do not always include a meta- analysis of the results . Other topics explored include underst and ing and interpreting discordant review s and the importance of reporting tools [ eg , QUality Of Reporting Of Meta-analyses ( QUOROM Statement ) or CONsoli date d St and ards Of Reporting of Trials ( CONSORT Statement ) ] . Recommendations are then provided , such as developing a capacity-building program , search ing the primary literature for research gaps , and extending reporting tools such as the QUOROM Statement to the field of nutrition Background and aims : Ulcerative colitis ( UC ) is an acute and chronic inflammatory disease of the large bowel with unknown aetiology . The immune response against normal commensal microorganisms is believed to drive inflammatory processes associated with UC . Therefore , modulation of bacterial communities on the gut mucosa , through the use of probiotics and prebiotics , may be used to modify the disease state . Methods : A synbiotic was developed for use in UC patients combining a probiotic , Bifidobacterium longum , isolated from healthy rectal epithelium , and a prebiotic ( Synergy 1 ) , a preferential inulin-oligofructose growth substrate for the probiotic strain . Treatment was employed in a double blinded r and omised controlled trial using 18 patients with active UC for a period of one month . Clinical status was scored and rectal biopsies were collected before and after treatment , and transcription levels of epithelium related immune markers were measured . Results : Sigmoidoscopy scores ( scale 0–6 ) were reduced in the test group ( start 4.5 ( 1.4 ) , end 3.1 ( 2.5 ) ) compared with placebo ( start 2.6 ( 2.1 ) , end 3.2 ( 2.2 ) ) ( p = 0.06 ) . mRNA levels for human beta defensins 2 , 3 , and 4 , which are strongly upregulated in active UC , were significantly reduced in the test group after treatment ( p = 0.016 , 0.038 , and 0.008 , respectively ) . Tumour necrosis factor α and interleukin 1α , which are inflammatory cytokines that drive inflammation and induce defensin expression , were also significantly reduced after treatment ( p = 0.018 and 0.023 , respectively ) . Biopsies in the test group had reduced inflammation and regeneration of epithelial tissue . Conclusions : Short term synbiotic treatment of active UC result ed in improvement of the full clinical appearance of chronic inflammation in patients receiving this therapy Abstract PURPOSE : Inflammation is a constant finding in the ileal reservoir of patients with an ileal pouch-anal anastomosis and is associated with decreased fecal concentrations of the short chain fatty acid butyrate , increased fecal pH , changes in fecal flora , and increased concentrations of secondary bile acids . In healthy subjects , inulin , a dietary fiber , is fermented to short chain fatty acids and leads to a lower pH and potentially beneficial changes in fecal flora . The aim of the present study was to investigate the effect of enteral supplementation of inulin on inflammation of the ileal reservoir . METHODS : Twenty patients received 24 g of inulin or placebo daily during three weeks in a r and omized , double-blind , crossover design . Stools were analyzed after each test period for pH , short chain fatty acids , microflora , and bile acids . Inflammation was assessed endoscopically , histologically , and clinical ly . RESULTS : Compared with placebo , three weeks of dietary supplementation with 24 g of inulin increased butyrate concentrations , lowered pH , decreased numbers of Bacteroides fragilis , and diminished concentrations of secondary bile acids in feces . This was endoscopically and histologically accompanied by a reduction of inflammation of the mucosa of the ileal reservoir . CONCLUSION : Enteral inulin supplementation leads to a decrease of inflammation-associated factors and to a reduction of inflammation of pouch mucosa Between 1 September 1980 and 31 August 1983 , 352 patients with inactive or mildly active Crohn 's disease but not taking drug treatment apart from sulphasalazine were entered from 40 hospitals into a prospect i ve trial to assess the effects of two different diets on disease activity over two years . One hundred and sixty two patients were r and omly allocated to take a diet unrestricted in sugar and low in fibre and 190 to a diet with little or no sugar and high in unrefined carbohydrate .  No clear difference in clinical course was detected among patients who accepted the two different types of dietary advice Twenty patients with ulcerative colitis in remission were asked to eat a high-fibre diet including 25 g bran daily and , if possible , to discontinue maintenance therapy with sulphasalazine . Only five patients ( 25 per cent ) were able to do this and remained in remission for six months . In contrast , of 15 patients asked to continue susphasalazine and their normal diet 12 ( 80 per cent ) remained in remission . A high-fibre diet is unable to replace sulphasalazine as maintenance treatment of ulcerative colitis in remission Germinated barley foodstuff ( GBF ) is a prebiotic which increases luminal butyrate production by modulating the microfloral distribution . GBF has been shown to reduce both clinical activity and mucosal damage in active ulcerative colitis ( UC ) with mild to moderate activity . However , the efficacy of GBF in patients with UC during the remission stage is unknown . The aim of this study was to investigate the efficacy of GBF as a maintenance therapy in patients with UC while in remission . Fifty-nine patients with UC in remission according to Rachmilewitz 's clinical activity index ( CAI ) score of < /=4 were enrolled and divided into two groups , control ( n=37 ) and GBF ( n=22 ) . Patients in the control group were given conventional treatment alone for 12 months , while patients in the GBF group received conventional therapy plus 20 g of GBF daily . The response to treatments was assessed by monitoring the CAI and endoscopic score according to Matts . Significantly better CAI values were seen in the GBF group at 3 , 6 , and 12 months compared with the values in the control group . The cumulative recurrence rate in the GBF group with steroid tapering treatment was significantly lower compared with the value in the control group . No side effects related to GBF were observed . GBF appeared to be effective and safe as a maintenance therapy to taper steroid dose and prolong remission in patients with UC 20 patients with Crohn 's disease took part in a controlled trial in which remission was maintained by either an unrefined carbohydrate fibre rich diet or a diet which excluded specific foods to which a patient was intolerant . 7 out of the 10 patients on the exclusion diet remained in remission for 6 months compared with none out of the 10 on an unrefined carbohydrate fibre rich diet ( p less than 0.05 , Fisher 's exact test ) . In an uncontrolled study an exclusion diet allowed 51 out of 77 patients to remain well on the diet alone for periods of up to 51 months , and with an average annual relapse rate of less than 10 % Seventy patients with non-stenosing Crohn 's disease were r and omly assigned to follow a low residue diet or a normal Italian diet for a mean of 29 months . The two groups were comparable at the onset in various measures of disease severity and diet . Patients complied well with the diet prescriptions , the low residue group eating a mean of 8.1 portions a week of fibre containing foods and the liberalized group a mean of 26.6 portions ( p less than 0.005 ) . There was no difference in outcome between the two groups , including symptoms , need for hospitalisation , need for surgery , new complications , nutritional status , or postoperative recurrence . Eighty six per cent of patients eating ad libitum and 65 % of patients who avoided roughage eliminated one or more permitted foods because of subjective intolerance . Lifting of dietary restrictions , which results in a more appetizing and nutritious diet , does not cause symptomatic deterioration or precipitate intestinal obstruction in Crohn 's disease OBJECTIVE Butyrate enemas may be effective in the treatment of active distal ulcerative colitis . Because colonic fermentation of Plantago ovata seeds ( dietary fiber ) yields butyrate , the aim of this study was to assess the efficacy and safety of Plantago ovata seeds 
    Output:
    