Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 8, 2020; 11(3): 59-68
Published online Aug 8, 2020. doi: 10.4292/wjgpt.v11.i3.59
Tongue thickness in health vs cirrhosis of the liver: Prospective observational study
Manish Tandon, Harshita Singh, Nishant Singla, Priyanka Jain, Chandra Kant Pandey
Manish Tandon, Harshita Singh, Chandra Kant Pandey, Formerly at Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Nishant Singla, Formerly at Department of Intervention Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Priyanka Jain, Formerly at Department of Research, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Author contributions: Tandon M conceived and wrote the manuscript and performed the literature search and review; Sigh H collected and compiled data and reviewed the literature; Singla N collected L3 skeletal muscle index data, trained others on ultrasonography measurements, and supervised ultrasonography measurements; Jain P performed statistical analysis of the data; Pandey CK reviewed the manuscript, and provided intellectual input.
Institutional review board statement: The study was reviewed and approved by the Review Board of the Institution of Liver and Biliary Sciences, New Delhi, India.
Clinical trial registration statement: The study titled “Study of thickness of tongue by ultrasound and its relation with severity of disease in patients with cirrhosis of liver: Prospective Study”, is registered with clinical trials registry of India vide No. CTRI/2017/10/010103.
Informed consent statement: All study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: No conflict of interest to declare.
Data sharing statement: There are no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Manish Tandon, MD, Doctor, Ex Additional Professor Anaesthesia, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India. manishtandon25@rediffmail.com
Received: December 29, 2019
Peer-review started: December 29, 2019
First decision: March 27, 2020
Revised: May 17, 2020
Accepted: May 21, 2020
Article in press: May 21, 2020
Published online: August 8, 2020
ARTICLE HIGHLIGHTS
Research background

Sarcopenia in patients with chronic liver disease has prognostic implications. L3 skeletal muscle index (L3SMI) calculated from computed tomography (CT) images is currently the only objective and reproducible method accepted for the quantification of sarcopenia. This study aims to determine tongue thickness measured using ultrasonography as an alternative method for diagnosing sarcopenia.

Research motivation

Sarcopenia in patients with chronic liver disease has prognostic implications. Wider application of L3SMI calculated from CT images is limited by cost, the need for extensive training, limited availability and due to the risk of radiation exposure. Clinical researchers have suggested the inclusion of a measure of sarcopenia in established prognostic models for patients with liver disease. A dependable and reproducible method with wider availability is therefore needed.

Research objectives

This study aimed to examine tongue thickness measured using ultrasonography as a dependable bedside tool for the diagnosis of sarcopenia. Significant differences were seen in tongue thickness between healthy individuals and individuals with less severe liver disease compared to patients with more severe chronic liver disease.

Research methods

Patients with chronic liver disease and healthy individuals who satisfied the inclusion criteria underwent tongue thickness measurement using ultrasonography. The study was observational in nature and no intervention was planned on the basis of observations made. Tongue thickness measurements were compared between healthy individuals and patients with liver disease of different severity. The imaging technique used was ultrasonography, which has wider availability and does not involve radiation exposure unlike CT scanning used to measure L3SMI.

Research results

Significant differences were seen in tongue thickness between healthy subjects and patients with less severe liver disease compared to patients with more severe liver disease. Tongue thickness measured using ultrasonography is therefore proposed as a bedside measure of sarcopenia. However, its application requires further validation in studies involving subjects of different ethnicity, in health and in disease.

Research conclusions

This study established consistent and significantly reduced tongue thickness in patients with severe liver disease compared to healthy individuals and patients with less severe liver disease. Tongue thickness measured using ultrasonography may therefore be used as a bedside tool for the diagnosis of sarcopenia, an application with wide availability and no risk of radiation exposure compared to CT-based measurement of L3SMI.

Research perspectives

The findings in this study require validation in a similar study of tongue thickness using ultrasonography in people of different ethnicity in health and in disease.