title: Alteration of the tongue manifestation reflects clinical outcomes of peptic ulcer disease.
abstract: OBJECTIVE
  This study investigated whether the tongue inspection technique in Traditional Chinese Medicine (TCM) can be used as a noninvasive auxiliary diagnostic tool to differentiate the subtypes of peptic ulcer disease (PUD) and as an indicator of therapeutic efficacy.
  
  
  METHODS
  A total of 198 outpatients from the China Medical University Hospital were recruited. The control group comprised 50 healthy adults. The remaining 148 patients were diagnosed with gastric ulcer, duodenal ulcer, or Helicobacter pylori (Hp) infection using upper gastrointestinal (GI) endoscopy, biopsy, and Campylobacter-like organism test. Tongue appearance was evaluated by a physician experienced in clinical Chinese medicine. Images of the tongue were immediately recorded using a high-resolution digital camera system.
  
  
  RESULTS
  The affected group of 148 patients received an 8-week course of ulcer therapy. Of these, 108 patients infected with Hp were subjected to triple therapy in the first week. Forty-nine of these 108 cases infected with Hp completed secondary examination of upper GI endoscopy and tongue inspection. Forty-one of 49 cases (83.7%) were fully cured of Hp infection. These results showed that the color of the tongue body did not change in the cured patients; however, tongue fur was markedly thinner with a color change to white (p<0.05), while sublingual veins with engorgement (p<0.05) and blood stasis (p<0.01) improved after the ulcer healed and Hp was eradicated.
  
  
  CONCLUSIONS
  TCM tongue inspection can be potentially used as a noninvasive auxiliary diagnostic method and as an indicator for clinical outcomes for patients with PUD.
authors.affiliation: Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Hwang-Huei
authors.initials: HH
authors.lastname: Wang
authors.forename: Chun-Hsu
authors.initials: CH
authors.lastname: Pan
authors.forename: Ping-Ping
authors.initials: PP
authors.lastname: Wu
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Luo
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Lin
authors.forename: Chieh-Hsi
authors.initials: CH
authors.lastname: Wu
mesh_terms: D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001706:Biopsy; D002167:Campylobacter; D016022:Case-Control Studies; D003116:Color; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional / Q000379:methods*; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D015203:Reproducibility of Results; D013276:Stomach Ulcer / Q000175:diagnosis* / Q000188:drug therapy; D013624:Taiwan; D014059:Tongue / Q000098:blood supply / Q000473:pathology; D016896:Treatment Outcome; D014680:Veins
chemical_list: D000897:Anti-Ulcer Agents