Purpose: Gut Working Tablet (GWT) is a Japanese traditional fermented medicine based on Aspergillus oryzae NK-fermented grain germ. Although GWT has been used by Japanese patients with constipation, the mechanism has not been investigated. The aim of this study was to examine the possible mechanisms of GWT on constipation.

Methods: Sprague-Dawley rats were fed with or without 5% of GWT for 2 weeks and administered loperamide. Number and weight of feces were measured for 24h after administration of loperamide. The concentration of short chain fatty acids (SCFA) in the cecal contents was measured. We measured stimulating effects of A. oryzae NK-fermented grain germ water extracts on the growth of B. longum and other intestinal bacteria in vitro.

Results: The decrease of feces caused by loperamide was improved by GWT administration. The decrease of butyric acid in feces and cecal contents induced by the administration of loperamide was inhibited by GWT. The growth of B. longum was increased in the presence of GWT and A. oryzae NK-fermented grain germ water extracts in a dose-dependent manner.

Conclusion: Administration of GWT restored constipation induced by loperamide. A. oryzae NK-fermented grain germ would be a useful prebiotics to stimulate the growth of Bifidobacterium.

Objective: To examine the effects of early resumption of oral intake by an early comprehensive swallowing training by multidiciplinary team in patients with aspiration pneumonia.

Methods: We enrolled 139 patients aged 65 years or older who were admitted to our hospital due to aspiration pnemonia and had been instructed to take nothing by mouth until prescription of swallowing training. 52 patients with mean (SD) age of 85.6 (7.2) years admitted from September 2012 to February 2013 were enrolled as a control group; and 87 patinets with mean (SD) age of 86.5 (7.0) years adimitted from September 2013 to February 2014, who recieved an early comprehensive swallowing training, were enrolled as an early intervention group. The various outcomes were compared between these groups.

Results: Days from admission to resumption of oral intake, duration of antibiotic therapy were significantly shorter in the early intervention group compared with the control group (3/5, 8/11, P<0.05,median). The rate of patients with the pneumonia recurrence during hospital stay were smaller in the early intervention group compared with the contorl gourp (6.9%/19.2%, P<0.05) . Days from admission to resumption of oral intake was an independent factor on shortening of antibiotic therapy(P=0.012).

Conclusion: Early resumption of oral intake promoted recovery in patients with aspiration pneumonia and reduced pneumonia recurrence.

Objective: We introduced modified medium-chain triglyceride (MCT) ketogenic food with added MCT oil as a diet with severe carbohydrate intake restriction for patients with colon cancer and examined its effectiveness.

Methods: We administered chemotherapy in combination with the modified MCT ketogenic diet at a ratio of 1.4:1 in 10 patients with stage IV recurrent colon cancer for 1 year. Response Evaluation Criteria in Solid Tumors (RECIST) classification, the presence of total blood ketone bodies, and Quality of Life (QOL) evaluations were compared against 14 patients in the chemotherapy-alone group.

Results: Patients in the chemotherapy-alone group revealed a response rate of 21% and disease control rate of 64% in 0 Complete Response (CR) cases, 3 Partial Response(PR) cases, 6 Stable Disease(SD) cases, and 5 Progressive Disease(PD) cases. Patients in the ketogenic diet combination group exhibited a response rate of 60%, disease control rate of 70% in 5 CR cases, 1 PR case, 1 SD case, and 3 PD cases. Chemotherapy with the 1-year ketogenic diet increased the CR rates by 50%.

Conclusion: Chemotherapy for 1 year in combination with a ketogenic diet revealed higher response rates and disease control rates than with chemotherapy alone. Therefore, the ketogenic diet may be a supportive therapy for stage IV colon cancer.

Aim: The aim of this study was to investigate the factors affecting physical deconditioning after curative resection for colonic cancer.

Subjects and Methods: Fifty-five patients with colonic cancer for whom surgical treatment was planned were enrolled in this study. Perioperative physical deconditioning was measured by changes in test results with the Short Physical Performance Battery before and after surgery, and subjects were categorized by the presence or absence of perioperative physical deconditioning. Before surgery, the following parameters were evaluated: body weight, body mass index, muscle mass, percentage of body fat, distance covered in the six-minute walk test, grip strength, leg strength, 10-m gait speed, serum albumin, and CRP. After surgery, the number of days until the start of early mobilization, number of days required before patients could walk around the hospital ward, nutrient adequacy, serum albumin, and CRP were measured.

Results: Subjects who experienced physical deconditioning after curative resection for colonic cancer required a significantly higher number of days before they began to regain mobility after surgery and had a higher postoperative CRP. In a multiple logistic regression analysis, the delay until early mobilization and a higher CRP after surgery were significant variables affecting physical deconditioning. Other measurements were not significantly related to perioperative physical deconditioning.

Conclusion: Postoperative early mobilization and inflammation were factors affecting physical deconditioning after curative resection for colonic cancer.

Aim: This study aims to reveal the food characteristics regarding “ Easiness or Difficulty to eat”of the meal contents for post Gastrectomy patients so that they can eat more comfortably in the long term.

Subjects and methods: 28 patients underwent Gastrectomy within a year had undergone semi-structured interviews and we analyzed their narrative response by using the contents analysis method.

Results: Five food characteristics associated with “ Easiness or Difficulty to eat” were showed: Taste, Smell, Texture, Food form and Digestion. Texture, Food form and Digestion were the characteristics with risk of the presence not only disturbance at their anastomotic region, gastric distension, and diarrhea, but also some postoperative complications such as ileus. Taste and Smell were related to their appetite.

Conclusions: We found that five food characteristics are affecting the symptoms related to food intake of the post Gastrectomy patients. It is important that we conduct dietary support and instruction on the basis of these characteristics.

Objective: In this study we investigated the effects of “HINE E-GEL^®” (enteral nutrition containing pectin, EG) on the defecation in aged patients with constipation.

Subjects and Methods: Fourteen enteral feeding patients were enrolled in this study. Fiber free enteral nutrition (FF) was administered for the first 2 weeks, followed by EG administration for 4 weeks. We compared the defecation patterns between the FF (FFP) administration period and the last 2 week EG (EGP) administration period. The primary outcome of this study was defecation frequency, and the secondary outcomes were fecal property, the number of days with defecation treatment, and change in intestinal flora.

Results: The significant increase was noted in defecation frequencies (number of days: P=0.002, number of times: P=0.01). In addition, the rate of normal phased feces in EGP was significantly increased compared with FFP (P=0.001). Furthermore, the number of days with defecation treatment in EGP was significantly decreased, compared with FFP (P=0.02). Lactobacillales showed an increasing tendency in EGP.

Conclusion: Results of this study suggest that EG may improve constipation in aged patients.