Oral Intake Group Research Articles

Advantages of nasogastric tube feeding during neoadjuvant concurrent chemoradiotherapy for esophageal cancer: A retrospective study

ObjectiveTo compare the effects of oral intake and nasogastric tube (NG) feeding on nutritional status, complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma (ESCC) patients. MethodsA total of 61 ​ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled, including (38 in oral intake group, and 22 in NG feeding group. Disease characteristics and baseline nutritional markers were collected in both groups. Nutritional status, complication and completion rate of chemoradiotherapy in both groups were evaluated. ResultsCompared with the oral intake group, patients in the NG feeding group had a later T stage (P ​= ​0.027) and clinical stage (P ​= ​0.014). The levels of energy intake (P ​= ​0.033), serum prealbumin (P ​< ​0.001), albumin (P ​= ​0.017) and hemoglobin (P ​= ​0.015) before treatment in NG group were significantly lower than those in oral intake group. Furthermore, patient-generated subjective global assessment (PG-SGA) score (P ​= ​0.016) and the levels of serum C-reactive protein (P ​= ​0.014) of NG feeding group were significantly higher than those of oral intake group. However, at the end of treatment, PG-SGA scores were increased in oral intake group and decreased in NG feeding group. In addition, the NG feeding group had a lower incidence of grade ≥2 esophagitis (P ​= ​0.037), and higher completion rate of chemotherapy compared with oral intake group (P ​= ​0.034). Meanwhile, the proportion of parenteral nutrition (P ​= ​0.008) and anti-inflammatory (P ​= ​0.022) treatment in NG feeding group was significantly lower than that in oral intake group. Although patients in the NG feeding group had a worse prognosis, there were no statistically significant differences in overall survival (OS) and progression-free survival (PFS) between the two groups (P ​> ​0.05). ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition, nasogastric tube feeding could increase treatment completion rate and reduce the incidence of ≥ grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.

Effects of PEG in patients with esophageal squamous cell carcinoma during concurrent chemoradiotherapy: a prospective study

This prospective study aimed to compare the changes in nutritional status and adverse events among patients with esophageal squamous cell carcinoma who received enteral nutrition through oral intake, PEG, and an enteral nasogastric tube (NGT) during concurrent chemoradiotherapy (CCRT). Of 141 included patients, 38, 74, and 29 patients were fed through oral intake, PEG, and NGTs, respectively. The clinical characteristics and baseline nutritional status of the 3 groups were recorded and analyzed. The Patient-Generated Subjective Global Assessment score, skeletal muscle index, and quality of life were evaluated before and after CCRT; the incidence of adverse events during feeding using PEG and NGTs was also recorded. The correlations among the different nutritional pathways and the CCRT-related adverse events (eg, radiation esophagitis and myelosuppression) were assessed. At baseline, the oral intake group had a significantly better nutritional status and lower disease stage than those in the PEG and NGT groups. However, during CCRT, the oral intake group exhibited the most significant decreases in weight and skeletal muscle index. The synchronous chemotherapy completion rate was the highest in the PEG group. Multivariate analysis showed that the planning tumor volume and oral intake and NGT feeding pathways were associated with radiation esophagitis of at least grade2. We found that PEG effectively maintained the body weight and skeletal muscle index of patients with esophageal cancer during CCRT. PEG also improved the synchronous chemotherapy completion rate and reduced the occurrence of at least grade 2 radiation esophagitis. (Clinical trial registration number: NCT04199832.).

The Kuchi‐kara Taberu index as a predictive marker of oral intake recovery in patients with aspiration pneumonia

In recent years, the Kuchi-kara Taberu (KT) index has been used as a new tool for the evaluation of dysphagia; however, its predictive ability remains unknown. This study was conducted to examine the validity of oral intake recovery prediction using the KT index in patients with aspiration pneumonia. The subjects were older inpatients admitted to an acute-care hospital for the treatment of aspiration pneumonia. A logistic regression analysis was conducted to clarify factors significantly associated with oral intake recovery. In addition, cut-off values of the predictors were calculated using a receiver operating characteristic curve analysis with the area under the curve (P < 0.05). A total of 124 patients (mean age 84.3 ± 7.9 years old, 70 males, 54 females) were enrolled in this study and divided into two groups at discharge: the oral intake group (62.1%) and the non-oral intake group (37.9%). The significant predictors of the recovery of oral intake were the pre-treatment period, treatment period, and the total score of the KT index; the respective odds ratios were 1.082 (95% confidence interval [CI] 1.013-1.156), 1.018 (1.003-1.033) and 0.850 (0.780-0.927), and the respective areas under the curve were 0.407 (95% CI 0.300-0.515), 0.304 (0.208-0.399), and 0.732 (0.640-0.824). The cut-off value of the total score of the KT index was 30. The model showed 85.7% sensitivity and 57.4% specificity. The KT index is suggested to be a valid variable for predicting whether or not a patient with aspiration pneumonia can recover their oral intake ability during acute-care hospitalization. Geriatr Gerontol Int 2023; 23: 221-226.

Monitoring energy balance through clinical and serum biomarkers in patients with hematologic malignancies undergoing chemotherapy.

Despite widespread concern about energy imbalance due to tumor and chemotherapy-related side effects, little is known about detailed variations in energy input, metabolic rate, and physical activity. This study explored changes in energy balance components and serum biomarkers of patients with hematologic malignancies undergoing chemotherapy. Our prospective study included 40 patients with hematologic malignancies hospitalized for chemotherapy. We measured energy balance components, physical function, and serum biomarkers at baseline and weekly after chemotherapy for 3weeks. Significant weight loss, representing negative energy balance, occurred at 2 (p = 0.002) and 3weeks (p < 0.001) post-chemotherapy. Statistically reduced oral intake was observed at 3weeks post-chemotherapy (p = 0.040), and resting energy expenditure statistically decreased according to Harris-Benedict equation, but not to Penn State University equation. Physical function according to DEMMI score decreased significantly at 3weeks post-chemotherapy (p = 0.002). Serum biomarker analysis demonstrated significant changes in albumin, total protein, CXCL13, and GDF15, with exception of leptin. Although conventional serum biomarkers (total protein and albumin) did not reach pathological states despite their statistical differences, subgroup analysis showed CXCL13 in weight loss group and GDF15 in reduced oral intake group were significantly changed. Over half of patients (65.0%, n = 26) suffered from energy imbalance associated with weight loss and reduced oral intake during chemotherapy. Serial laboratory results suggested that novel biomarkers (CXCL13, GDF15) could be correlated with cachexic state and reduced food intake. Monitoring clinical and serum biomarkers associated with energy balance together can help identify needs for nutritional support in patients with hematologic malignancies undergoing chemotherapy.

Early versus the traditional start of oral intake following esophagectomy for esophageal cancer: a systematic review and meta-analysis.

Nil by mouth is considered the standard of care during the first days following esophagectomy. However, with the routine implementation of enhanced recovery after surgery, early oral intake is more likely to be the preferred mode of nutrition following esophagectomy. The present study aims to evaluate the safety and effectiveness of early oral intake following esophagectomy for esophageal cancer. Comprehensive literature searches were conducted using PubMed, Web of Science, Embase, and Cochrane Library. Weighted mean differences (WMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated as the effect sizes for continuous and dichotomous variables, respectively. Fourteen studies with a total of 1947 patients were included. Length of hospital stay (WMD = - 3.94, CI: - 4.98 to - 2.90; P < 0.001), the time to first flatus (WMD = - 1.13, CI: - 1.25 to - 1.01; P < 0.001) and defecation (WMD = - 1.26, CI: - 1.82 to - 0.71; P < 0.001) favored the early oral intake group. There was no statistically significant difference in mortality (OR = 1.23, CI: 0.45 to 3.36; P = 0.69). Early oral intake also did not increase the risk of pneumonia and overall postoperative complications. Current evidence indicates early oral intake following esophagectomy seems to be safe and effective. It may be the preferred mode of nutrition following esophagectomy. However, more high-quality studies are still needed to further validate this conclusion.

Factors associated with oral intake ability in patients with acute-stage stroke

To investigate the factors predicting oral feeding ability following acute stroke. This retrospective study compared patients admitted to a stroke care unit in 2 groups: an oral intake group and a tube feeding group. The groups were evaluated for 28 items and initial blood investigation tests, and the results compared. Logistic regression analysis was used to identify the clinical variables significantly associated with oral feeding ability. A total of 255 stroke patients (162 in the oral intake group and 93 in the tube feeding group) were admitted to the stroke care unit. Significant differences were observed between the 2 groups for 20 items. Logistic analysis found that the following variables were significant in the prediction model: age, date of initiation of oral feeding, stroke recurrence/patient deterioration during hospitalization, and date of initiation of occupational therapy. Factors associated with achieving oral intake among stroke care unit patients were: young age at time of admission; starting oral intake early; no stroke recurrence/patient deterioration during hospitalization; and achieving rehabilitation of daily activities early during the physical function recovery stage.

Effects of artificial nutrition and hydration on survival in patients with head and neck cancer and esophageal cancer admitted to palliative care units

<h2>Summary</h2><h3>Background</h3> The benefits of artificial nutrition and hydration in patients with head and neck cancer and esophageal cancer in the late stage remain unknown. We performed a secondary analysis of a cohort study to investigate the effects of enteral tube feeding (ETF) and parenteral nutrition and hydration (PNH) on survival in this population. <h3>Methods</h3> Patients with head and neck cancer and esophageal cancer admitted to palliative care units were included. Information on primary nutritional administration routes during the first week of admission and data on the averaged calorie sufficiency rate/total calorie intake, e.g., 75%≤/750 kcal/day≤ and <25%/<250 kcal/day, were obtained. Patients were divided into oral intake-, ETF-, and PNH-groups. We performed time-to-event analyses using the Kaplan-Meier method, Log-rank test, and univariate and multivariate Cox regression analyses. <h3>Results</h3> There were 33 patients in the oral intake-group, 25 in the ETF-group, and 44 in the PNH-group. A significant difference was observed in survival rates between these groups (Log-rank P=0.002), and median survival times were 54.0 (95% CI 33–75), 26.0 (95% CI 13–39), and 18.0 (95% CI 14–22) days, respectively. In the multivariate-adjusted model, the oral intake-group had a significantly lower risk of mortality than the PNH-group [HR 0.46 (95% CI 0.28–0.76), P=0.002], while the ETF-group had a markedly lower risk of mortality than the PNH-group [HR 0.60 (95% CI 0.34–1.06), P=0.077]. <h3>Conclusions</h3> These results indicate the potentially beneficial effects of ETF for patients with head and neck cancer and esophageal cancer in palliative care.

Evaluating the Use of Oral Trials for Inpatient Dysphagia Management: An Initial Cross-Sectional Database Study

Purpose Oral trials, otherwise known as swallow trials or tasters, are widely used in dysphagia management. However, to date, no studies have investigated the effectiveness of oral trials or outlined how the approach is utilized in everyday practice. This article aims to start a dialogue regarding this much-used but little-evidenced dysphagia intervention by exploring three main aspects to (a) identify the patient demographics and environments in which oral trials are used in hospital, (b) explore clinical decision making around the approach, and (c) consider clinical implications around current findings and future areas for research. Method A cross-sectional examination of 118 patients on the dysphagia caseload of a United Kingdom-based inpatient speech and language therapy team was conducted. Statistical analysis explored demographic differences between oral trials groups and the rest of the dysphagia caseload. Results Twenty-three of 118 (19.5%) individuals on the caseload were or had been on oral trials during admission. Individuals in the oral trials group were significantly more likely to have a neurological diagnosis than the full oral intake group (78.3% vs. 30.5%, p < .001). There was a lack of uniformity in oral trials recommendations, and the rationale behind quantity and types of diet or fluids offered was unclear. Conclusions This study begins to evidence the use of a dysphagia therapy not previously explored within existing literature. It highlights the wide use of oral trials within the hospital trust observed. Based on current evidence, it would be difficult for clinicians to know how to implement oral trials as an intervention. Further research is required both to explore the effectiveness of this approach and also to develop a consensus within practice around how, why, and when oral trials are offered. This would ensure an equitable and effective service is offered and would ensure a high standard of evidence-based practice within dysphagia management.

Impact of rehabilitation treatment on swallowing during adjuvant radiotherapy following surgery in patients with oral and oropharyngeal cancer.

Patients with advanced oral or oropharyngeal cancer sometimes require surgery and adjuvant postoperative radiotherapy (PORT), which may cause dysphagia. However, the efficacy of rehabilitation treatment for PORT-induced dysphagia remains unclear. This study aimed to determine whether rehabilitation treatment during PORT after surgery is effective for dysphagia. We retrospectively studied 55 patients with oral or oropharyngeal cancer who received PORT. Of these, 25 received rehabilitation treatment for swallowing during PORT. The Functional Oral Intake Scale (FOIS) score at 6 months after treatment was used as the swallowing outcome. We performed multivariate linear regression and stratified analyses using the FOIS score (poor oral intake group: FOIS score <5, good oral intake group: FOIS score ≧5) before PORT. The median (interquartile range) FOIS scores at 6 months post-PORT were 6 (5-6) and 6 (4-7) in the non-rehabilitation and rehabilitation groups, respectively. Multivariate linear regression revealed that rehabilitation treatment was a significant independent factor for a better FOIS score. Stratified analysis of the changes in the FOIS score from pre-PORT values to those obtained 6 months after treatment showed a significant difference in the good oral intake group between the rehabilitation and non-rehabilitation groups. There was no significant difference in the FOIS score from pre-PORT values to those obtained 6 months after treatment between the rehabilitation and non-rehabilitation groups in the poor oral intake group. Rehabilitation treatment during PORT may achieve better swallowing outcomes in patients with advanced oral or oropharyngeal cancer.

Effect of Postoperative Oral Intake on Prognosis for Esophageal Cancer.

Background: Patients undergoing surgery for esophageal cancer are at risk of prolonged hospital stay for postoperative malnutrition. Postoperative early oral feeing is a part of the “enhanced recovery after surgery protocol” for coping with this risk. However, the usefulness of early oral intake during perioperatively is questionable. Methods: In total, 117 patients treated surgically for esophageal cancer were analyzed in the study. We assessed the oral energy sufficiency rate per nutritional requirement (oral-E/NR) at the fourth week postoperatively and classified the patients into two groups: Poor oral intake group (POI group; <25% oral-E/NR) and the control group (≥25% oral-E/NR). We analyzed the relationship among postoperative oral intake and prognoses. Results: The POI group had worse postoperative nutritional status and a lower survival rate than the control group. In a multivariate analysis, <25% oral-E/NR was one of the independent factors contributing to negative outcomes postoperatively (adjusted hazard ratio: 2.70, 95% confidence interval: 1.30–5.61). Conclusions: In patients undergoing surgery for esophageal cancer, poor postoperative oral intake negatively affected not only on their postoperative nutritional status but also their overall prognosis. It is necessary to improve the adequacy of oral intake postoperatively for patients with esophageal cancer.

Delay in Oral Feeding is Associated With a Decrease in Anastomotic Leak Following Transhiatal Esophagectomy

The cervical anastomotic leak is a major complication of transhiatal esophagectomy and results in chronic strictures in up to half of patients. A change in postoperative protocol to delaying initiation of oral intake was made with the goal of reducing anastomotic leak rate and associated sequelae. A postoperative protocol change was applied to all patients undergoing elective transhiatal esophagectomy. Rate of anastomotic leak and anastomotic stricture, defined as defect in the esophagogastric anastomosis and narrowing of the anastomosis, respectively, were compared between pre- and post-change groups. Between 2004 and 2013, 203 patients underwent transhiatal esophagectomy with cervical anastomosis. Historically, oral intake was resumed on postoperative day 3, and during the course of the study, a change was made to the protocol to delay oral intake until 15 days postoperatively. Eighty-three patients were in the early oral feeding group (postoperative day 3), and 120 were in the delayed oral intake group (postoperative day 15). There was a statistically significant decrease in the rate of anastomotic leak from 14.5% to 4.2% between the early and delayed intake groups, respectively (P = 0.0089). There was also a trend (P = 0.05) towards a lower rate of anastomotic stricture in all patients in the delayed intake group (15.8%) compared with those in the early feeding group (27.7%). By increasing the time to postoperative oral feeding, we have noted an associated improvement in both immediate and long-term outcomes of elective transhiatal esophagectomy patients.

A comparison of the swallowing function and quality of life by oral intake level in stroke patients with dysphagia.

[Purpose] This study was conducted to compare the swallowing function and quality of life (QOL) in stroke patients with dysphagia by oral intake level. [Subjects and Methods] Seventy-nine stroke patients with dysphagia were enrolled. All subjects were evaluated by using the Swallowing Function Test (SFT) and the Swallowing Quality of Life (SWAL-QOL) questionnaire. The subjects were divided into two group based on the SFT score: oral intake (OI) and non-oral intake (NOI) groups. The SFT and SWAL-QOL scores were then compared between the groups. [Results] There were significant differences in items in the SFT, except for the respiratory item, between the OI group and the NOI group. There were significant differences in all items on the SWAL-QOL, except for the sleep item, between the OI group and the NOI group. [Conclusion] Oral intake was positively associated the swallowing function and QOL in stroke patients with dysphagia. Safe intervention using oral intake treatments during dysphagia rehabilitation may have a positive effect on the patients’ swallowing function and QOL.

Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer.

Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed. There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p < 0.001). 2) Severe cases of dry mouth (Grade-2&3) were noted in 20.0% and 64.8% in good and poor oral intake groups, respectively ( p < 0.0001). Candidiasis complication rate was significantly higher in poor oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3. Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

Temporal trends in oral intake ability 3 months after acute ischaemic stroke: Analysis of a single-centre database from 2003 to 2011

To analyse the 9-year trend in oral intake ability 3 months after onset in acute stroke patients, with a view to indirect clarification of advances in acute stroke treatment and swallowing rehabilitation. A database of patients admitted to our hospital (Saiseikai Kumamoto Hospital, Kumamoto) with acute ischaemic stroke between 2003 and 2011 was analysed. Exclusion criteria were: patients with premorbid modified Rankin Scale score ≥ 1; those who died during hospital stay; and those whose outcomes after 3 months were not recorded. Mode of nutritional intake was investigated with a questionnaire posted to the patient 3 months after stroke onset. Patients were divided into 2 groups according to mode of nutritional intake: an oral intake group and a non-oral intake group. Whether the date or year of admission were related to the proportion of patients with oral intake, independent of other factors, was investigated using a logistic regression model. Of a total of 2,913 patients, 2,677 (91.9%) were included in the oral intake group. The proportion of patients with oral intake 3 months after stroke increased significantly over the period of analysis (p = 0.034 by Cochran-Armitage test). On logistic regression analysis, the trend was significant after adjustment for age, sex, vascular risk factors, stroke subtype, and stroke severity on admission (odds ratio 1.098, 95% confidence interval 1.029-1.173; per 1 year). The proportion of ischaemic stroke patients in the institution studied who were capable of oral intake at 3 months post-stroke increased significantly over the past decade, independent of other patient characteristics.

Efficacy and ethics of artificial nutrition in patients with neurologic impairments in home care

Outcomes, particularly survival, for home-care patients with neurologic impairments who receive artificial nutrition, such as home parenteral nutrition (HPN) or percutaneous endoscopic gastrostomy (PEG) feeding, remain unclear. The efficacy of tube feeding for life prolongation in elderly patients remains controversial. The aim of this study was to assess the survival of elderly patients with neurologic impairments after the start of HPN or PEG. We retrospectively evaluated 80 patients with neurologic impairments who had received home care before they died. They were divided into three groups according to feeding method: oral-intake group (n=23), HPN group (n=21) and PEG group (n=36). The factors considered were: age; survival period after commencement of home care; swallowing function; serum albumin concentration; level of activities of daily living (ADL); and behavioral, cognitive and communication functions. Survival periods of the patients in the PEG (736±765days) and HPN (725±616days) groups were twice that of the self-feeding oral-intake group (399±257days) despite lower serum albumin concentration (for PEG patients), reduced swallowing function and cognitive function, and poorer levels of ADL at the start of home care. Almost all patients were incapable of deciding whether they should receive artificial nutrition due to dementia or poor comprehension. Physicians should provide clinical evidence to families before commencing PEG feeding or HPN and support their decisions to maintain the dignity of the patient.

Efficacy of Cilostazol in Preventing Aspiration Pneumonia in Acute Cerebral Infarction

This retrospective study examined the effectiveness of cilostazol in preventing aspiration pneumonia in patients with acute cerebral infarction. The 189 subjects ranged in age from 31 to 95 years and included 57 with small-artery occlusion, 107 with large-artery atherothrombosis, and 25 with other disorders. Patients with cardiogenic cerebral embolism or preexisting pneumonia at the time of hospital admission were excluded from the analysis. Neurologic symptoms, cognitive function, and swallowing function were assessed at the first clinical examination, and the ability to perform activities of daily living was assessed at both hospital admission and discharge. Outcome and food intake status were also assessed at hospital discharge. Pneumonia was detected in 27 of 189 subjects (14.3%), in 20 subjects during nasogastric tube feeding implemented because of oral intake difficulties (fasting group) and in 7 subjects after initiation of oral feeding (oral intake group). Cilostazol was administered to 48 of the 189 subjects (25.4%). The incidence of pneumonia was 6.3% (3 of 48) in patients who received cilostazol, compared with 17% (24 of 141) in those who did not receive cilostazol. Our data suggest that cilostazol appears to prevent the occurrence of pneumonia in both the chronic and acute stages of cerebral infarction.

Early oral intake after reconstruction with a free flap for cancer of the oral cavity

To allow healing of the surgical wound patients are traditionally given nothing by mouth for 6–12 days after resection and reconstruction of a cancer of the oral cavity. Our aim was to assess the impact of introducing oral intake within 6 days postoperatively. Consecutive patients who had resection and reconstruction of a cancer of the oral cavity with a free flap within an 8-year period were selected from the head and neck database. Personal and social data; type, stage, and site of the tumour; type of resection and free flap; postoperative complications; and duration of hospital stay were recorded, supplemented by review of casenotes for the time that oral intake was started, duration of nasogastric and tracheostomy intubation, and changes in body weight. Patients in the early oral intake group started oral intake within 5 days postoperatively, and those in the late group began feeding from postoperative day 6. The duration of hospital stay in the early group was significantly shorter than that in the late group. There was, however, no difference in the morbidity, including orocutaneous fistula, between the two groups. The duration of nasogastric and tracheostomy intubation was shorter, and weight loss was less, in the early group than in the late group, but not significantly so. Early oral feeding does not increase the morbidity for patients having resection and reconstruction with free flaps for cancers of the oral cavity. Early oral intake is associated with a shorter hospital stay, and this may have implications for improved postoperative outcome.

Hepatoprotection of different water extracts from Acer tegmentosum M. on CCl4-induced acute hepatotoxicity in mice: comparative efficacies between the extracts of boughs, twigs, and leaves

While Acer tegmentosum M. (AT) has been widely used as a popular folk remedy to prevent or treat liver diseases in Korea, the scientific evidences for the usage of AT against liver disease are poorly documented. To address this issue, we compared hepatoprotection of hot water extract (WEAT) from three parts of AT, boughs (E1), twigs (E2), and leaves (E3), on CCl4-induced acute hepatic injury in mice by way of morphometric and biochemical examination: liver function test, antioxidant enzymes activity of liver, histopathological and ultrastructural examination of liver, and antioxidant capacity (DPPH assay) of WEAT. We found that only oral intake group of WEAT-boughs showed significant differences in aspartate transaminase (AST), alanine transaminase (ALT) levels and glutathione peroxidase (GPx) activities as compared to CCl4 control group, whereas the glutathione levels were significantly low in all WEAT-pretreated groups. Consistently, histopathological and ultrastructural findings displayed hepatoprotection in the order of WEAT-boughs >WEAT-twigs>WEAT-leaves. Collectively, these results indicate that of three WEAT, WEAT-bough extract has the highest hepatoprotection against CCl4-induced acute hepatic injury in mice via the possible regulation of antioxidant enzyme activities in liver.