<33322D3220C7D1C0C7C7D0C8B8C1F62E687770>42
⋅Received31 January 2011 ⋅Revised28 February 2011 ⋅Accepted28 February 2011
⋅Correspondence to(Jinsung Kim)
Tel+82-2-958-8895, Fax+82-2-958-9136, E-mailoridoc@khu.ac.kr
97
1, 1, 2, 1
Original Article
Gajin Han1, Jinsung Kim1, Jae-Woo Park2, Bongha Ryu1
13rd Department of Internal Medicine, Hospital of Oriental Medicine, Kyung Hee University 2Department of Internal Medicine, Hospital of Oriental Medicine at Gangdong, Kyung Hee University
Objective: This study was designed to identify and explore the pathological patterns of functional dyspepsia (FD) patients. We also evaluated the usefulness of the Pattern Identification Questionnaire by comparing it with other assessment tools for FD. Methods: We recruited 97 FD patients based on the Rome III criteria for FD diagnosis. The pathological patterns of the subjects were determined by the Pattern Identification Questionnaire. Their dyspepsia-related symptoms were assessed using the Gastrointestinal Symptom Questionnaire (GIS) and the Pyeongwi-san (Pingwei-san) Patternization Questionnaire. Depressive symptoms were evaluated with the Beck Depression Inventory (BDI) and quality of life with the Functional Dyspepsia-Related Quality of Life (FD-QoL) Questionnaire. Tongue coating was measured by the Digital Tongue Diagnosis System (DTDS). Results: The male to female ratio was 1:1.1, and the forties and fifties age groups were largest in number. The spleen deficiency and phlegm-dampness pattern was the most common pattern found among the FD patients. No significant differences in the GIS, BDI, FD-QoL, and DTDS scores were found among the five pattern types. All pattern types showed significant correlation with GIS, Pyeongwi-san Patternization Questionnaire, and FD-QoL scores. Conclusions: Pattern Identification Questionnaire can not only identify the pathological pattern types of FD patients but also evaluate the severity of their symptoms. Compared to conventional assessment tools for FD, it could enable a more dynamic evaluation of FD patients reflecting the severity of dyspeptic symptoms and the quality of life. Further studies on the Pattern Identification of FD patients are anticipated in order to improve the diagnosis and therapy for Korean FD patients.
Key Words : Functional dyspepsia (FD), Pattern Identification Questionnaire, Gastrointestinal Symptom Questionnaire (GIS), Pyeongwi-san (Pinwei-san) Patternization Questionnaire, Beck Depression Inventory (BDI), Functional Dyspepsia-Related Quality of Life (FD-QoL), Digital Tongue Diagnosis System (DTDS)

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Table 1. Rome Diagnostic Criteria for Functional Dyspepsia5)
Rome Diagnostic Criteria for Functional Dyspepsia Criteria fulfilled for the last 3months with symptom onset at least 6 months prior to diagnosis
Functional dyspepsia One or more of bothersome postprandial fullness, early satiation, epigastric pain, epigastric burning and no evidence of structural disease(including at upper endoscopy) that is likely to explain the symptoms. 1. Postprandial distress syndrome (PDS)
Bothersome postprandial fullness, occurring after ordinary sized meals, at least several times per week. Early satiation that prevents finishing a regular meal, at least several times per week. - Supportive criteria Upper abdominal bloating or postprandial nausea or excessive belching can be present. EPS may coexist.
2. Epigastric pain syndrome (EPS) Pain or burning localized to the epigastrium, of at least moderate severity at least once per week The pain is intermittent Not generalized or localized to other abdominal or chest regions Not relieved by defecation or passage of flatus Not fulfilling criteria for biliary pain. - Supportive criteria The pain may be of a burning quality, but without a retrosternal component. The pain is commonly induced or relieved by ingestion of a meal, but may occur while fasting. PDS may coexist.
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Table 2. Pattern Identification Questionnaire18)
Liver depression and qi stagnation 0 1 2 3 . . . . . . . . . Liver depression and spleen deficiency 0 1 2 3 . . . . . . . . . Spleen deficiency and phlegm-dampness 0 1 2 3 . .* . . . . . . Food accumulation 0 1 2 3 . . . . . . . Cold-heat complex 0 1 2 3 . . . . . . . .

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Fig. 1. The external and internal composition of the digital tongue diagnosis system.
The interface for patient’s facial part was designed to easily introduce the patient’s tongue to inner digital camera. The internal composition contains a computer system with a software and two other parts(image acquisition and illumination part).
Winkel Tongue Coating Index(WTCI) = A + B + C + D + E + F
0 = NO COATING
1 = LIGHT COATING
2 = HEAVY COATING
Fig. 2. Winkel tongue coating index35).
The dorsum of the tongue was divided into 6 areas from the vallate papillae to the tip, and tongue coating was assessed in each sextant as ‘0 = no coating’, ‘1 = light coating’, ‘2 = severe coating’. Especially, the differentiation between light coating and severe coating is based on whether the pink color underneath the coating is visible. Winkel tongue coating index was obtained by addition of all 6 scores, range 0-12.
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Fig. 3. The program display of the digital tongue diagnosis system.
Acquired tongue image(left), extracted tongue coating image(middle), and score diagram of tongue coating(right). (The value in figure is examples.)
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Fig. 4. Age distribution of patients with functional dyspepsia.
1 : 10-19 years old / 2 : 20-29 years old 3 : 30-39 years old / 4 : 40-49 years old 5 : 50-59 years old / 6 : 60-69 years old 7 : 70-79 years old.
F
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Fig. 5. Distribution of patients with functional dyspepsia by pattern identification(The tie scores of pattern identification were excluded).
M : Male / F : Female.

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32 2 (2011 3)
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Fig. 6. Distribution of patients with functional dyspepsia by pattern identification(The tie scores of pattern identification were included).
M : Male / F : Female.
Table 7. Comparisons of GIS‡, BDI§, FD-QoL between Five Types of Pattern Identification
Liver depression and
FD -QoL 60.39 62.60 48.86 41.00 50.27 0.305
*P-value is calculated by Kruskal-Wallis H. †Value means mean rank. ‡Gastrointestinal Symptom. §Beck Depression Inventory. Functional Dyspepsia-Related Quality of Life.
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Table 8. Comparisons of Tongue Coating Score between Five Types of Pattern Identification
Liver depression and
±28.18 44.79c
±14.46 47.82c
±19.84 54.34c
±6.82 29.92c
±19.80 0.625
*P-value is calculated by one-way analysis of variance(ANOVA). †Tongue coating score was measured by Digital Tongue Diagnosis System. a, b, c Same letters indicate no statistical significance based on Bonferroni correction.
Table 9. The Correlation between Five Items of Pattern Identification and GIS‡and Pyeongwi-san(pingwei-san) Patternization
GIS‡ Pyeongwi-san Patternization
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Table 10. The Correlation between Five Items of Pattern Identification and BDI‡
Liver depression and qi stagnation
Liver depression and
0.554*
*Significantly correlated by Spearman’s rank correlation analysis (two-tailed). †P-value. ‡Beck Depression Inventory.
Table 11. The Correlation between Five Items of Pattern Identification and FD-QoL‡
Total FD-QoL‡
(240)
57
Average age (yr) 48.61±13.58 34.88±13.17 32.5
Male : Female 1:1.1 1:2 1:4.8
Higest Pattern Identification type
Spleen deficiency and phlegm-dampness
the stomach
Study A16) : Analysis of symptom pattern through comprehensive diagnosis of Qui Xui Shui in patients with functional dyspepsia. Study B17) : Analytic study of 68 patients with functional dyspepsia according to syndrome differentiation.
Table 12. Comparison of This Study with The Other Previous Studies
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