The relationship between abnormal tongue features and non-malignant upper gastrointestinal disorders: A hospital-based cross-sectional study

Inflammation, ulcer, reflux, polyp, and metaplasia or dysplasia of the upper gastrointestinal tract are frequently encountered non-malignant upper gastrointestinal disorders (NUGDs) in clinical practice. Abnormal tongue features (ATFs) are a series of morphological changes occurring on the dorsal surface of the tongue according to traditional Chinese medicine theory. Red tongue, purple tongue, yellowish, greasy tongue, fissured tongue, teeth-printed tongue, ecchymotic tongue, peeled or geographically coated tongue are the most frequently encountered ATFs and show a close relationship to chronic diseases. This study was to investigate the prevalence of ATFs in NUGDs and to explore the potential correlation between them. This was a cross-sectional study conducted at China–Japan Friendship Hospital, China. Patients aged over 18 years old and met the standards set for upper gastrointestinal endoscopy in the endoscopic center were included. The tongue images of all the participants were captured using a smart phone. The seven ATFs were determined using a manual-interpretation-based, computer-aided tongue diagnosis method by three TCM practitioners.The participants were then categorized into different NUGDs according to endoscopic findings and pathological examinations. Chi-square test was performed to analyze the distribution differences of ATFs by gender and age. Univariate and multivariate logistic regression analyses were used to determine the relationship between ATFs and NUGDs. Among disease manifestations, inflammation (98.2%) and gastroesophageal reflux disease (62.4%) were highly prevalent, whereas fissured tongue (34.3%) was the most common ATF. The prevalence of ATFs was significantly influenced by gender and age. Fissured tongue, red tongue, and yellowish, greasy tongue (all P < 0.01) were more prevalent in men, whereas purple tongue and ecchymotic tongue (all P < 0.001) were more prevalent in women. Multivariate logistic regression analysis revealed fissured tongue as an independent factor for upper gastrointestinal precancerous lesions (UGPLs) (OR, 1.51; 95% CI, 1.04–2.20). Fissured tongue was found to be related to the UGPLs. Since the participants of this study were from a hospital-based population, a multi-center, community-based study is warranted to confirm these results in the future.