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 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 Background Experimental studies have shown that luminal antigens are involved in chronic intestinal inflammatory disorders such as Crohn 's disease and ulcerative colitis . Alteration of the intestinal microflora by antibiotic or probiotic therapy may induce and maintain remission . The aim of this r and omized , placebo-controlled trial was to determine the effect of oral Lactobacillus GG ( L. GG ) to induce or maintain medically induced remission . Methods Eleven patients with moderate to active Crohn 's disease were enrolled in this trial to receive either L. GG ( 2 × 109 CFU/day ) or placebo for six months . All patients were started on a tapering steroid regime and received antibiotics for the week before the probiotic/placebo medication was initiated . The primary end point was sustained remission , defined as freedom from relapse at the 6 months follow-up visit . Relapse was defined as an increase in CDAI of > 100 points . Results 5/11 patients finished the study , with 2 patients in each group in sustained remission . The median time to relapse was 16 ± 4 weeks in the L. GG group and 12 ± 4.3 weeks in the placebo group ( p = 0.5 ) . Conclusion In this study we could not demonstrate a benefit of L. GG in inducing or maintaining medically induced remission in CD BACKGROUND AND AIMS : Intestinal bacteria have been implicated in the initiation and perpetuation of IBD ; in contrast , “ probiotic bacteria ” have properties possibly effective in treating and preventing relapse of IBD . We evaluated the safety and efficacy of VSL#3 and the components , and the composition of the biopsy-associated microbiota in patients with active mild to moderate ulcerative colitis ( UC ) . METHODS : Thirty-four ambulatory patients with active UC received open label VSL#3 , 3,600 billion bacteria daily in two divided doses for 6 wk . The presence of biopsy-associated bacteria was detected using a nucleic acid-based method and the presence of VSL#3 species confirmed by DNA sequencing of 16S rRNA . RESULTS : Thirty-two patients completed 6 wk of VSL#3 treatment and 2 patients did not have the final endoscopic assessment . Intent to treat analysis demonstrated remission ( UCDAI ≤ 2 ) in 53 % ( n = 18 ) ; response ( decrease in UCDAI ≥ 3 , but final score ≥3 ) in 24 % ( n = 8) ; no response in 9 % ( n = 3 ) ; worsening in 9 % ( n = 3 ) ; and failure to complete the final sigmoidoscopy assessment in 5 % ( n = 2 ) . There were no biochemical or clinical adverse events related to VSL#3 . Two of the components of VSL#3 were detected by PCR/DGGE in biopsies collected from 3 patients in remission . CONCLUSION : Treatment of patients with mild to moderate UC , not responding to conventional therapy , with VSL#3 result ed in a combined induction of remission/response rate of 77 % with no adverse events . At least some of the bacterial species incorporated in the probiotic product reached the target site in amounts that could be detected OBJECTIVES : An increased prevalence of elevated serum anti-Saccharomyces cerevisiae antibody ( ASCA ) levels in patients with Crohn 's disease ( CD ) has been described . The aim of the present work was to investigate serum ASCA levels during the courses of prednisolone and mesalamine therapy in CD patients . METHODS : Serum sample s of 25 patients with active CD were studied for ASCA levels before as well as 2 and 9 wk after initiation of a prednisolone tapering regimen . The influence of mesalamine ( 4 g o.d . ) on serum ASCA levels compared to that of placebo was tested over 1 yr in 38 patients ( 20 mesalamine and 18 placebo ) participating in a postoperative prophylaxis study .  Serum IgG and IgA ASCA levels were measured by ELISA . Sera of 91 CD and 40 ulcerative colitis ( UC ) patients as well as 334 healthy donors were tested for ASCA to recalculate new cut-off values . RESULTS : For IgG ASCA cut-off values were determined to be 17.0 U and 25.0 U , and for IgA ASCA 9.3 U and 14.0 U. At baseline visit , 73.0 % ( 46/63 ) of patients displayed serum ASCA positivity . During prednisolone therapy , a decrease in serum IgG and IgA ASCA levels from baseline to wk 2 ( p < 0.0001 and p < 0.001 , respectively ) as well as to wk 9 ( p < 0.001 and p= 0.01 , respectively ) was observed . A trend toward an association of ASCA positivity and steroid responsiveness was calculated ( p= 0.07 ) . During mesalamine treatment , no differences in changes of ASCA levels were observed compared to placebo at any time point . CONCLUSION : ASCA are stable markers during steroid and mesalamine treatment , highlighting their reliability for use in diagnosis of CD BACKGROUND & AIMS Pouchitis is the major long-term complication after ileal pouch-anal anastomosis for ulcerative colitis . Most patients have relapsing disease , and no maintenance treatment study has been performed . We evaluated the efficacy of a probiotic preparation ( VSL#3 ) containing 5 x 10(11 ) per gram of viable lyophilized bacteria of 4 strains of lactobacilli , 3 strains of bifidobacteria , and 1 strain of Streptococcus salivarius subsp . thermophilus compared with placebo in maintenance of remission of chronic pouchitis . METHODS Forty patients in clinical and endoscopic remission were r and omized to receive either VSL#3 , 6 g/day , or an identical placebo for 9 months . Patients were assessed clinical ly every month and endoscopically and histologically every 2 months or in the case of a relapse . Fecal sample s were collected for stool culture before and after antibiotic treatment and each month during maintenance treatment . RESULTS Three patients ( 15 % ) in the VSL#3 group had relapses within the 9-month follow-up period , compared with 20 ( 100 % ) in the placebo group ( P < 0.001 ) . Fecal concentration of lactobacilli , bifidobacteria , and S. thermophilus increased significantly from baseline levels only in the VSL#3-treated group ( P < 0.01 ) . CONCLUSIONS These results suggest that oral administration of this new probiotic preparation is effective in preventing flare-ups of chronic pouchitis BACKGROUND Seventy percent of Crohn 's disease ( CD ) patients exhibit anastomotic recurrence within 1 year after ileo-caecal surgery . Recent clinical trials suggest the beneficial use of probiotics in the control of intestinal inflammation in pouchitis and ulcerative colitis . This study is a multicenter clinical trial evaluating the efficacy of an oral administration of the probiotic LAl on early post-operative endoscopic recurrence of CD . METHODS Seventy patients with CD were enrolled prior to elective ileo-caecal resection and r and omly assigned after surgery to daily treatment with either Lactobacillus johnsonii , LA1 , Nestle ( 1010 colony-forming units , CFU ) ( group A , n = 34 ) or placebo ( group B , n = 36 ) for 12 weeks . The primary objective was to assess the effect of LAl on the endoscopic recurrence rate at 12 weeks . Stratification was performed according to smoking status at r and omization . RESULTS Seven and 14 patients were excluded in the LA1 and placebo groups , respectively . In intention-to-treat analysis , the mean endoscopic score was not significantly different between the two treatment groups at 3 months ( LA1 versus placebo : 1.50 + /- 1.32 versus 1.22+/-1.37 , treatment effect : P = 0.48 , smoke effect : P = 0.72 ) . The percentage of patients with severe recurrence ( i3 + i4 ) was 21 % and 15 % in the LAl and placebo groups , respectively ( P = 0.33 ) . Using a per- protocol ( PP ) analysis , the mean endoscopic score was not significantly different between the two treatment groups ( LAl versus placebo groups : 1.44 + /-1.31 versus 1.05 + /- 1.21 , P = 0.32 ) . The percentage of patients with severe recurrence ( i3 + i4 ) was 19 % and 9 % in the LAl and placebo groups , respectively ( P = 0.054 ) . Clinical relapse rate ( CDAI [ CD activity index ] > 150 , with an increase of CDAI > 70 points or greater from baseline ) in the LAl and placebo groups was 15 % ( 4/27 ) and 13.5 % ( 3/22 ) , respectively ( PP analysis : chi-square test , P = 0.91 and log-rank test : P = 0.79 ) . CONCLUSION Oral administration of the probiotic LA1 in patients with CD failed to prevent early endoscopic recurrence at 12 weeks after ileo-caecal resection Background : Anti‐Saccharomyces cerevisiae mannan antibodies have been proposed as a new serological marker associated with Crohn 's disease . However , their clinical value is still unclear ; furthermore , a st and ardization of anti‐S. cerevisiae mannan measurements is lacking BACKGROUND Ulcerative colitis has been suggested to be caused by infection and there is circumstantial evidence linking Escherichia coli with the condition . Our aim was to find out whether the administration of a non-pathogenic strain of E. coli ( Nissle 1917 ) was as effective as mesalazine in preventing relapse of ulcerative colitis . We also examined whether the addition of E. coli to st and ard medical therapy increased the chance of remission of active ulcerative colitis . METHODS This was a single-centre , r and omised , double-dummy study in which 120 patients with active ulcerative colitis were invited to take part . 116 patients accepted ; 59 were r and omised to mesalazine and 57 to E. coli .  All patients also received st and ard medical therapy together with a 1-week course of oral gentamicin . After remission , patients were maintained on either mesalazine or E. coli and followed up for a maximum of 12 months . A two-stage , conditional , intention-to-treat analysis was done . FINDINGS 44 ( 75 % ) patients in the mesalazine group attained remission compared with 39 ( 68 % ) in the E. coli group . Mean time to remission was 44 days ( median 42 ) in the mesalazine group and 42 days ( median 37 ) for those treated with E. coli . In the mesalazine group , 32 ( 73 % ) patients relapsed compared with 26 ( 67 % ) in the E. coli group . Mean duration of remission was 206 days in the mesalazine group ( median 175 ) and 221 days ( median 185 ) in the E. coli group . INTERPRETATION Our results suggest that treatment with a non-pathogenic E. coli has an equivalent effect to mesalazine in maintaining remission of ulcerative colitis . The 
    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 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 Background Experimental studies have shown that luminal antigens are involved in chronic intestinal inflammatory disorders such as Crohn 's disease and ulcerative colitis . Alteration of the intestinal microflora by antibiotic or probiotic therapy may induce and maintain remission . The aim of this r and omized , placebo-controlled trial was to determine the effect of oral Lactobacillus GG ( L. GG ) to induce or maintain medically induced remission . Methods Eleven patients with moderate to active Crohn 's disease were enrolled in this trial to receive either L. GG ( 2 × 109 CFU/day ) or placebo for six months . All patients were started on a tapering steroid regime and received antibiotics for the week before the probiotic/placebo medication was initiated . The primary end point was sustained remission , defined as freedom from relapse at the 6 months follow-up visit . Relapse was defined as an increase in CDAI of > 100 points . Results 5/11 patients finished the study , with 2 patients in each group in sustained remission . The median time to relapse was 16 ± 4 weeks in the L. GG group and 12 ± 4.3 weeks in the placebo group ( p = 0.5 ) . Conclusion In this study we could not demonstrate a benefit of L. GG in inducing or maintaining medically induced remission in CD BACKGROUND AND AIMS : Intestinal bacteria have been implicated in the initiation and perpetuation of IBD ; in contrast , “ probiotic bacteria ” have properties possibly effective in treating and preventing relapse of IBD . We evaluated the safety and efficacy of VSL#3 and the components , and the composition of the biopsy-associated microbiota in patients with active mild to moderate ulcerative colitis ( UC ) . METHODS : Thirty-four ambulatory patients with active UC received open label VSL#3 , 3,600 billion bacteria daily in two divided doses for 6 wk . The presence of biopsy-associated bacteria was detected using a nucleic acid-based method and the presence of VSL#3 species confirmed by DNA sequencing of 16S rRNA . RESULTS : Thirty-two patients completed 6 wk of VSL#3 treatment and 2 patients did not have the final endoscopic assessment . Intent to treat analysis demonstrated remission ( UCDAI ≤ 2 ) in 53 % ( n = 18 ) ; response ( decrease in UCDAI ≥ 3 , but final score ≥3 ) in 24 % ( n = 8) ; no response in 9 % ( n = 3 ) ; worsening in 9 % ( n = 3 ) ; and failure to complete the final sigmoidoscopy assessment in 5 % ( n = 2 ) . There were no biochemical or clinical adverse events related to VSL#3 . Two of the components of VSL#3 were detected by PCR/DGGE in biopsies collected from 3 patients in remission . CONCLUSION : Treatment of patients with mild to moderate UC , not responding to conventional therapy , with VSL#3 result ed in a combined induction of remission/response rate of 77 % with no adverse events . At least some of the bacterial species incorporated in the probiotic product reached the target site in amounts that could be detected OBJECTIVES : An increased prevalence of elevated serum anti-Saccharomyces cerevisiae antibody ( ASCA ) levels in patients with Crohn 's disease ( CD ) has been described . The aim of the present work was to investigate serum ASCA levels during the courses of prednisolone and mesalamine therapy in CD patients . METHODS : Serum sample s of 25 patients with active CD were studied for ASCA levels before as well as 2 and 9 wk after initiation of a prednisolone tapering regimen . The influence of mesalamine ( 4 g o.d . ) on serum ASCA levels compared to that of placebo was tested over 1 yr in 38 patients ( 20 mesalamine and 18 placebo ) participating in a postoperative prophylaxis study .  Serum IgG and IgA ASCA levels were measured by ELISA . Sera of 91 CD and 40 ulcerative colitis ( UC ) patients as well as 334 healthy donors were tested for ASCA to recalculate new cut-off values . RESULTS : For IgG ASCA cut-off values were determined to be 17.0 U and 25.0 U , and for IgA ASCA 9.3 U and 14.0 U. At baseline visit , 73.0 % ( 46/63 ) of patients displayed serum ASCA positivity . During prednisolone therapy , a decrease in serum IgG and IgA ASCA levels from baseline to wk 2 ( p < 0.0001 and p < 0.001 , respectively ) as well as to wk 9 ( p < 0.001 and p= 0.01 , respectively ) was observed . A trend toward an association of ASCA positivity and steroid responsiveness was calculated ( p= 0.07 ) . During mesalamine treatment , no differences in changes of ASCA levels were observed compared to placebo at any time point . CONCLUSION : ASCA are stable markers during steroid and mesalamine treatment , highlighting their reliability for use in diagnosis of CD BACKGROUND & AIMS Pouchitis is the major long-term complication after ileal pouch-anal anastomosis for ulcerative colitis . Most patients have relapsing disease , and no maintenance treatment study has been performed . We evaluated the efficacy of a probiotic preparation ( VSL#3 ) containing 5 x 10(11 ) per gram of viable lyophilized bacteria of 4 strains of lactobacilli , 3 strains of bifidobacteria , and 1 strain of Streptococcus salivarius subsp . thermophilus compared with placebo in maintenance of remission of chronic pouchitis . METHODS Forty patients in clinical and endoscopic remission were r and omized to receive either VSL#3 , 6 g/day , or an identical placebo for 9 months . Patients were assessed clinical ly every month and endoscopically and histologically every 2 months or in the case of a relapse . Fecal sample s were collected for stool culture before and after antibiotic treatment and each month during maintenance treatment . RESULTS Three patients ( 15 % ) in the VSL#3 group had relapses within the 9-month follow-up period , compared with 20 ( 100 % ) in the placebo group ( P < 0.001 ) . Fecal concentration of lactobacilli , bifidobacteria , and S. thermophilus increased significantly from baseline levels only in the VSL#3-treated group ( P < 0.01 ) . CONCLUSIONS These results suggest that oral administration of this new probiotic preparation is effective in preventing flare-ups of chronic pouchitis BACKGROUND Seventy percent of Crohn 's disease ( CD ) patients exhibit anastomotic recurrence within 1 year after ileo-caecal surgery . Recent clinical trials suggest the beneficial use of probiotics in the control of intestinal inflammation in pouchitis and ulcerative colitis . This study is a multicenter clinical trial evaluating the efficacy of an oral administration of the probiotic LAl on early post-operative endoscopic recurrence of CD . METHODS Seventy patients with CD were enrolled prior to elective ileo-caecal resection and r and omly assigned after surgery to daily treatment with either Lactobacillus johnsonii , LA1 , Nestle ( 1010 colony-forming units , CFU ) ( group A , n = 34 ) or placebo ( group B , n = 36 ) for 12 weeks . The primary objective was to assess the effect of LAl on the endoscopic recurrence rate at 12 weeks . Stratification was performed according to smoking status at r and omization . RESULTS Seven and 14 patients were excluded in the LA1 and placebo groups , respectively . In intention-to-treat analysis , the mean endoscopic score was not significantly different between the two treatment groups at 3 months ( LA1 versus placebo : 1.50 + /- 1.32 versus 1.22+/-1.37 , treatment effect : P = 0.48 , smoke effect : P = 0.72 ) . The percentage of patients with severe recurrence ( i3 + i4 ) was 21 % and 15 % in the LAl and placebo groups , respectively ( P = 0.33 ) . Using a per- protocol ( PP ) analysis , the mean endoscopic score was not significantly different between the two treatment groups ( LAl versus placebo groups : 1.44 + /-1.31 versus 1.05 + /- 1.21 , P = 0.32 ) . The percentage of patients with severe recurrence ( i3 + i4 ) was 19 % and 9 % in the LAl and placebo groups , respectively ( P = 0.054 ) . Clinical relapse rate ( CDAI [ CD activity index ] > 150 , with an increase of CDAI > 70 points or greater from baseline ) in the LAl and placebo groups was 15 % ( 4/27 ) and 13.5 % ( 3/22 ) , respectively ( PP analysis : chi-square test , P = 0.91 and log-rank test : P = 0.79 ) . CONCLUSION Oral administration of the probiotic LA1 in patients with CD failed to prevent early endoscopic recurrence at 12 weeks after ileo-caecal resection Background : Anti‐Saccharomyces cerevisiae mannan antibodies have been proposed as a new serological marker associated with Crohn 's disease . However , their clinical value is still unclear ; furthermore , a st and ardization of anti‐S. cerevisiae mannan measurements is lacking BACKGROUND Ulcerative colitis has been suggested to be caused by infection and there is circumstantial evidence linking Escherichia coli with the condition . Our aim was to find out whether the administration of a non-pathogenic strain of E. coli ( Nissle 1917 ) was as effective as mesalazine in preventing relapse of ulcerative colitis . We also examined whether the addition of E. coli to st and ard medical therapy increased the chance of remission of active ulcerative colitis . METHODS This was a single-centre , r and omised , double-dummy study in which 120 patients with active ulcerative colitis were invited to take part . 116 patients accepted ; 59 were r and omised to mesalazine and 57 to E. coli .  All patients also received st and ard medical therapy together with a 1-week course of oral gentamicin . After remission , patients were maintained on either mesalazine or E. coli and followed up for a maximum of 12 months . A two-stage , conditional , intention-to-treat analysis was done . FINDINGS 44 ( 75 % ) patients in the mesalazine group attained remission compared with 39 ( 68 % ) in the E. coli group . Mean time to remission was 44 days ( median 42 ) in the mesalazine group and 42 days ( median 37 ) for those treated with E. coli . In the mesalazine group , 32 ( 73 % ) patients relapsed compared with 26 ( 67 % ) in the E. coli group . Mean duration of remission was 206 days in the mesalazine group ( median 175 ) and 221 days ( median 185 ) in the E. coli group . INTERPRETATION Our results suggest that treatment with a non-pathogenic E. coli has an equivalent effect to mesalazine in maintaining remission of ulcerative colitis . The 
    Output:
    