Nakayama et al. Journal of Medical Case Reports 2010, 4:24 http://www.jmedicalcasereports.com/content/4/1/24 Page 3 of 4 Figure 2 Chronological change of hemoglobin concentration (square), serum albumin concentration (circle) and C-reactive protein titer (triangle). Anti-tuberculosis drugs were started on the first day of admission (arrow a). Liquid nutrition was increased to 1,200 kcal/day on the 14th day of admission (arrow b). Semi-solid nutrition of 1,200 kcal/day was started on the 21st day of admission (arrow c). Debridement of the sacral pressure ulcer was conducted on the 22nd day of admission (arrow d). was transferred to another facility for further recuperation. Discussion Our case report showed that nutrition improvement and curative effects were obtained by nutrition with a higher viscosity of about 20,000 mPa × s. In recent years, the advantages of semi-solid nutrition over liquid nutrition have been reported [3]. Liquid nutrition may not be the best choice when it is needed to shorten the administra- tion time and at the same time provide a sufficient amount of calories. A small-bore nasogastric tube is thus recommended from a viewpoint of compliance. However, in this case, liquid nutrition was not appropri- ate, and so we had no choice but to use a large-bore nasogastric tube. Due to its higher viscosity, semi-solid nutrition has several advantages. One advantage is the reduction of gastroesophageal reflux with the resultant prevention of aspiration pneumonia [3]. The rate of proximal stomach emptying contributes to the number of reflux episodes per hour [7]. Nutrition with higher viscosity promotes the passage of gastric content to the intestinal tract, which shortens the gastric retention time [3,8]. Another advantage is the prevention or improvement of diarrhea. We used semi-solid nutrition for patients with intract- able diarrhea who had been administered with liquid nutrition. Improvement of diarrhea was observed in 9 out of 14, or 64.2% of patients (unpublished data). The third advantage is that semi-solid nutrition can shorten the duration of administration. The bolus administration of liquid nutrition induces gastroesophageal reflux. Hence, in order to prevent the reflux, continuous administration is required [9]. The manufacturer of the nutrition we used for this patient recommends that the administration of the semi-solid nutrition be done in 15 minutes. Administration should be carried out in a sit- ting position to minimize gastroesophageal reflux, but this position may impose load to any pressure ulcer at the sacral region. In order to administer semi-solid nutrition in a short time, we changed the size of our patient’s nasogastric tube from small-bore to 18 French, and the pressure ulcer that had existed for a long time disappeared in 3 months. As for amelioration of the pressure ulcer, the favorable effects of debridement and the antibacterial effect of anti-tuberculosis drugs must be taken into con- sideration. However, it is established that nutrition improvement is indispensable for the amelioration of a pressure ulcer [10,11]. Hence, we believe that shortening the administration time of nutrition largely contributed to the improvement of our patient’s pressure ulcer. It is not recommended to administer semi-solid nutri- tion through a thinner tube with high pressure because the liquid spouting from the tip may injure the gastric mucosa. When semi-solid nutrition is given via a naso- gastric tube, there is a risk for tube obstruction, but we avoided this by using a large-bore tube. Conclusions When patients have problems with liquid nutrition, such as diarrhea or gastroesophageal reflux, semi-solid nutri- tion via a nasogastric tube is a useful method for improving nutrition in a short period of time. Consent Written informed consent was obtained from the patient for publication of this case report and any