Lim Yun-Seo, Son Chang-Gue, Lee Jin-Hee, Yang Sung-Don, Park Daeui, Rho Gi-Hwan, Choi Gyu-Ho, Choi Seo-Hyung
Department of Integrative Medicine, Wooje Research Institute for Integrative Medicine, Seoul 06200, Republic of Korea.
Department of Internal Medicine, Weedahm Korean Medicine Hospital, Seoul 06185, Republic of Korea.
Healthcare (Basel). 2025 Sep 15;13(18):2307. doi: 10.3390/healthcare13182307.
: A subset of patients with chronic dyspepsia exhibits palpable upper abdominal hardness and systemic symptoms like headache, chest discomfort, neck/shoulder stiffness, fatigue, and depression. In traditional Korean medicine (TKM), this symptom complex is referred to as syndrome (, DJS). Although DJS is frequently observed in TKM practice, it lacks a clear case definition and biological mechanism, limiting its integration in gastroenterology research and evidence-based practice. Clarifying its clinical and biological features is essential to understand its pathophysiology and clinical significance. : This case-control study aimed to characterize DJS by comparing 16 female patients diagnosed with DJS and 15 age-matched healthy females as controls. A female-only cohort was selected to reflect the higher prevalence of chronic dyspepsia in women and reduce biological variability. Clinical characteristics and potential DJS-specific biomarkers were evaluated through complete blood count (CBC), serum biochemical tests, heart rate variability (HRV) for autonomic function, and plasma 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite linked to gastrointestinal motility and autonomic regulation. : The DJS group had a mean disease duration of 58.0 ± 46.2 months, with epigastric fullness and underlying abdominal hardness as primary complaints. Postprandial distress syndrome (PDS) was the most common (43.8%) dyspepsia subtype, often combined with epigastric pain syndrome (EPS). Extra-gastrointestinal symptoms such as headache/fatigue (87.5%) and anxiety/depression (81.3%) were highly prevalent. Neutrophil counts were significantly lower in the DJS group ( = 0.01), while other hematological or biochemical markers showed no differences ( > 0.1). HRV analysis revealed decreased parasympathetic activity (RMSSD and HF, < 0.1), and plasma 5-HIAA levels were significantly elevated compared to healthy controls ( = 0.01). : DJS aligns with functional gastrointestinal disorders (FGIDs), sharing psychosomatic symptoms and reduced parasympathetic activity, suggesting gut-brain axis dysregulation. However, distinct features like palpable upper abdominal hardness and elevated plasma 5-HIAA levels indicate that DJS may represent a unique subtype within the category of FGIDs. These findings highlight the need for larger, well-designed studies to further elucidate the pathophysiology of DJS.
一部分患有慢性消化不良的患者表现出上腹部可触及的硬结以及诸如头痛、胸部不适、颈部/肩部僵硬、疲劳和抑郁等全身症状。在传统韩医学（TKM）中，这种症状复合体被称为 证（DJS）。尽管DJS在TKM实践中经常被观察到，但它缺乏明确的病例定义和生物学机制，限制了其在胃肠病学研究和循证医学实践中的整合。阐明其临床和生物学特征对于理解其病理生理学和临床意义至关重要。：本病例对照研究旨在通过比较16例被诊断为DJS的女性患者和15例年龄匹配的健康女性作为对照来描述DJS的特征。选择仅女性队列是为了反映女性中慢性消化不良的较高患病率并减少生物学变异性。通过全血细胞计数（CBC）、血清生化检测、用于自主神经功能的心率变异性（HRV）以及血浆5-羟吲哚乙酸（5-HIAA）（一种与胃肠动力和自主神经调节相关的血清素代谢产物）来评估临床特征和潜在的DJS特异性生物标志物。：DJS组的平均病程为58.0±46.2个月，主要症状为上腹部饱胀和腹部硬结。餐后不适综合征（PDS）是最常见的（43.8%）消化不良亚型，常与上腹部疼痛综合征（EPS）合并。诸如头痛/疲劳（87.5%）和焦虑/抑郁（81.3%）等胃肠道外症状非常普遍。DJS组的中性粒细胞计数显著更低（ = 0.01），而其他血液学或生化标志物无差异（ > 0.1）。HRV分析显示副交感神经活动降低（RMSSD和HF， < 0.1），并且与健康对照相比血浆5-HIAA水平显著升高（ = 0.01）。：DJS与功能性胃肠疾病（FGIDs）相符，具有心身症状和副交感神经活动降低，提示肠-脑轴失调。然而，诸如上腹部可触及的硬结和血浆5-HIAA水平升高这些独特特征表明DJS可能代表FGIDs类别中的一种独特亚型。这些发现凸显了需要进行更大规模、设计良好的研究以进一步阐明DJS的病理生理学。
