Objective tongue color and gastroesophageal reflux disease: Cross‐sectional study

• Published in: Traditional & Kampo medicine 2019-04, Vol.6 (1), p.19-25
• Main Authors: Kainuma, Mosaburo, Furusyo, Norihiro, Urita, Yoshihisa, Ikezaki, Hiroaki, Ura, Kazuya, Nakaguchi, Toshiya, Namiki, Takao
• Format: Article
• Language: English
• Subjects: Frequency Scale for the Symptoms of GERD; gastroesophageal reflux disease; reflux esophagitis; tongue color; tongue image analyzing system
• ISSN: 2053-4515; 2053-4515
• DOI: 10.1002/tkm2.1210

ABSTRACT Aim Gastroesophageal reflux disease (GERD) is a heterogeneous, multi‐symptom disease. The Frequency Scale for the Symptoms of GERD (FSSG) is used to evaluate the disease severity and therapeutic response. We reported that objective tongue diagnosis would be a useful, non‐invasive screening tool for erosive gastritis, which makes it a useful complement to Kampo diagnosis. This study was done to investigate the utility of tongue color (TC) and FSSG in the diagnosis of GERD. Methods A total of 886 healthy Japanese residents aged 28–86 years had a photograph of the tongue taken, completed the FSSG, and underwent esophagogastroduodenoscopy. FSSG ≥8 was defined as GERD, mucosal break on endoscopy as reflux esophagitis (RE), and no erosive esophagitis as non‐erosive reflux disease (NERD). TC was measured using the device‐independent International Commission on Illumination (CIE) 1976 L*a*b* color space standards at four points. Results A total of 152 (17.2%) of the subjects had FSSG ≥8. On endoscopy 36 (4.1%) had RE and 116 (13.1%) had NERD. Age, sex, and smoking were significant in the multivariate analysis of GERD (OR, 0.64, P = 0.043; OR, 0.65, P = 0.036; and OR, 2.06, P = 0.014, respectively). Sex and TC (3b*/1b*) were significant in the multivariate analysis of RE (OR, 4.82, P < 0.001; OR, 3.59, P = 0.018, respectively). On receiver operating characteristics analysis, a combination of sex (male) and TC (3b*/1b*) ≥1.24 was more predictive of RE than sex (male) alone (area under the curve, 0.75 vs 0.70). Conclusion Combining FSSG ≥8, sex, and a positive tongue color coating would be a useful, accurate, non‐invasive screening method for GERD, especially RE.