Informatics in Medicine Unlocked 15 (2019) 100169

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Informatics in Medicine Unlocked

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Treatment of peptic ulcers with a Siddha medicine, “Sirucinni Uppu” and T

prediction with regression models
Kumaravel Appavooa,∗, Mudiganti Ram Krishna Raob
a
School of Computing, India
b
Bharath Institute of Higher Education and Research, Department of Industrial Biotechnology, 173, Agaram Road, Tambaram, 600073, Chennai, India

A R T I C LE I N FO A B S T R A C T

Keywords: Application of computational tools in medical science can assist physicians with analysis of disease. Herein,
Siddha prediction based on a subset featured approach with the Siddha medical treatment dataset is utilized for peptic
Peptic ulcer ulcers, using a simple linear regression (LR) based model as predictor, and measuring its effectiveness via error
Acalypha fruticosa estimates and statistical significances. The herbal salt of Acalypha fruticosa (Siruccini Uppu) is dissolved in dis-
Sirucinni uppu
tilled water and administered to peptic ulcer patients in standard doses with honey before diet. The results were
Gummam
Prediction
tabulated to show efficacy of treatment. Clinically ‘Sirucinni uppu’ is shown as an effective medicine in treating
Linear regression ‘Gunmam’ (peptic ulcer) patients with 80% satisfactory result, 10% fair, and 10% moderate result. The present
Gaussian processes analysis is beneficial in the effective usage of patterns and relationships reflected in datasets collected from real
Error estimate cases of peptic ulcer disease treatment. This approach of using such algorithms for early diagnosis of peptic
ulcers could be employed by physicians to treat these patients more effectively.

1. Introduction treatment. This paper presents a prediction model based on a medical

Peptic ulcers are a prevalent disease, and each year peptic ulcer
disease (PUD) affects four million people around the world [1]. The
pathophysiology of PUD involves an imbalance between offensive fac-
tors (Acid, Pepsin, and H. pylori) and defensive factors (Mucin, Pros-
taglandins, Bicarbonate, Nitric oxide and Growth factors). Considering
the several side effects (impotence, gynaecomastia and haematopoeitic
changes) of modern pharmcologic agents, indigenous drugs possessing
fewer side effects might better treat peptic ulcers sans side effects. The
clinical studies for the efficacy of herbal salt extracted from ‘Acalypha
fruticosa’ (HSAF) on gastric ulcers was found. HSAF was effective on
human subjects with peptic ulcer without perceptible side effects.
During the last few decades, various computational tools have been
shown to be of value to medical practitioners in evaluating, diagnosing
and treating patients in a more effective and realistic way. This com-
bination of medical science and computational science has provided
excellent value for predicting the disease [2]. The early and accurate
diagnosis and prediction of peptic ulcer can effectively reduce mor-
bidity and mortality due to chronic conditions such as perforation,
bleeding, and onset of malignancy. Thus, an accurate and reliable
technique is necessary, with predictive capabilities. Our findings in this
regard are beneficial in the development of effective usage of patterns
and relationships, reflected in datasets collected with real cases of PUD
treatment dataset, an approach by using a simple linear regression (LR)-
based model as predictor, and measures its effectiveness through error
estimates and statistical significance. The advantages of applying LR
over other models are its simplicity and interpretability for establishing
the correlation between each feature and the prognosis [3,4]. The us-
ability of LR as a base learner is evaluated by performing experimental
analysis with a dataset consisting of a sample cohort of small size (60
instances), and its effectiveness is established based on significant
performance. The aim of the present study is therefore to develop a
prediction model which can assist physicians in decision-making while
reducing false negative cases.
2. Model background
The objective of this study is to generate a regression model with
statistically significant methods for the prediction of the prognosis of
peptic ulcer with standard dosage practice in Siddha, a form of alter-
native medicine. The uniqueness of such alternative forms of medicinal
practice include their cost effectiveness, easy of availability, and time-
tested authenticity. The database for peptic ulcer cure was procured
from the work of Rao et al, 2014 [5]. The data of sixty patients were
taken for the present study. The time in days for the relief or cure of
symptoms of peptic ulcer patients, such as epigastric pain, flatulence,

∗
Corresponding author.
E-mail addresses: drkumaravel@gmail.com (K. Appavoo), mrkrao1455@gmail.com (M.R. Krishna Rao).

https://doi.org/10.1016/j.imu.2019.100169

Available online 26 March 2019

2352-9148/ © 2019 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
K. Appavoo and M.R. Krishna Rao Informatics in Medicine Unlocked 15 (2019) 100169

indigestion, loss of appetite, vomiting, sore tongue and constipation
were recorded. The patients were from both sexes and of different age
groups. The dose of Sirucinni uppu was administered ranging from
130 mg to 500 mg B.D. with honey before diet, and the study period
varied from 7 days to 15 days, and to a maximum duration of 40 days.
The clinical experimental protocol for ‘Shirucinni uppu’ (AJ/IAEC/10/
12) was approved by the CPCSEA/IAEC of Mohamed Sathak A.J College
of Pharmacy, Sholinganallur, Chennai, India.
3. Proposed algorithm
The main method applied in the present report, namely linear re-
gression, addresses the problem of estimating the output value based on
inputs. Here the main output is prognosis, along with other outputs
including flatulence and epigastric pain as symptoms for peptic ulcer.
The linear model to be fit must try to minimize the sum of squares error
(deviations between the data points and the regression line) is re-
presented by
y = c0 + c1x1 + … ….+ cnxn
Criteria (exclusion): Complications of peptic ulcer including he-
morrhage, perforation, gastric outlet obstruction, radiating abdominal
pain as can occur in pancreatitis, appendicitis, acute abdominal colic,
cancer of the stomach, gall stones, hiatal hernia, cirrhosis of the liver,
and jaundice excluded patients from the study, because such patients
would require invasive treatment.
Criteria for withdrawal: Irregular medication, irregular follow-
ups.
Routine examination and assessment: The full details of patient
history and physical examination of the patients was recorded as per
the Proforma. The clinical assessment was done initially at the end of 4
days, 7 days, 14 days and 21 days follow-up.
Incidence of PUD is higher in male (64%) than female The occur-
rence was 26% in age group 40 to 49; 18% between 50 and 69% and
14% between 20 and 39 years. Duration of treatment varied from 8
days to 28 days depending upon patient condition. The average treat-
ment period was 12–18 days. Improvement from the disease is recorded
from the history of prognosis, which showed relief of different symp-
toms, as follows:

By determining the regression coefficients c0, c1, …cn, the re- i. 52% of patients relieved of gastric pain and nausea in three days,
lationship between the output attribute, y, and the input variables x1, 32% in 4 days, 12% in five days, and 4% in six days. 56% of patients
… …, xn can be estimated [6–9]. obtained relief from flatulence in four days, 30% in three days, 8%
in five days and 6% in six days.
ii. 20% of patients were relieved of indigestion in three days, 42% in
4. Dataset description
four days, 22% in five days, 14% in six days and 2% in seven days.
In total, 80% of patients reported satisfactory improvement, and
The symptoms playing the roles of attributes in the data set are
20% improved fairly. Ten PUD patients were admitted and provided
explained briefly here.
treatment. Of these, 50% were male and 50% female, aged between
Epigastric pain: Peptic ulcer can cause pain in the upper part of the
19 and 68 years. The patients improved in a period six to eleven
stomach just below the breast bone and often just after taking food.
days from their symptoms, and were then discharged. 60% of pa-
Flatulence: The feeling of bloating of the stomach leading to dis-
tients were relieved of epigastric pain and indigestion in four days,
comfort and difficulty in breathing. This can also cause belching.
30% in five days and 10% in three days. 60% of patients were re-
Indigestion and Loss of appetite: Usually peptic ulcers are formed by
lieved of flatulence in five days, 20% in four and 20% in three days.”
excessive release of stomach acid or due to the presence of a bacterium,
Helicobactor pylori. The ulcer can cause discomfort, leading to improper
Fig. 1 indicates the system architecture for the proposed study, in
digestion and loss of appetite.
Vomiting: Due the excessive acidity in the stomach, vomiting is a
common phenomenon in peptic ulcer patients.
Sore tongue: As the digestion is disturbed in peptic ulcer patients,
their tongue develops inflamed taste buds, manifested as small painful
bumps and red color. This condition is highly irritable, and the patient
feels discomfort in chewing, swallowing and speaking.
Constipation: Constipation is one of the major effects of peptic ulcer,
due to a disturbed and unregulated digestion process. The bowel
movement of patients becomes irregular, which can lead to further
complications to the digestive system and the general physiology.
The dataset instances were generated from the records filled during
the treatment procedure and duration as follows. The data and de-
scription of peptic ulcer treatment with SU were followed from Rao
et al, 2014, [5].

5. Study participants

Both men and women, and members of all the races and ethnic
groups, were eligible for this trial. Treatment was administered on an
Inpatient/Outpatient basis. The sample size was 60 patients, and these
were selected from the Arignar Anna Government Hospital of Indian
Medicine and Homeopathy, Chennai-600006.

6. Criteria for selection

Criteria (inclusion): patients with epigastric pain, heart burn, re-

gurgitation, nausea/vomiting, loss of appetite, abdominal discomfort,
flatulence, indigestion, sore tongue and constipation, which were signs
of initial stages of peptic ulcer, were included for this treatment. Fig. 1. System architecture for the proposed study.

2
K. Appavoo and M.R. Krishna Rao Informatics in Medicine Unlocked 15 (2019) 100169

Table 1
Statistical description of the Eight attributes in the dataset for peptic ulcer
treatment.
Sl. No Symptom Maximum Minimum Mean Standard
Deviation

1 Prognosis 28 5 13.1831 5.003

2 Epigastric Pain 6 3 3.75 0.836
3 Flatulence 6 3 3.967 0.802
4 Indigestion 7 3 4.37 0.988
5 Improved Appetite 7 3 4.283 0.976
6 Relief from 6 3 3.733 0.8
Vomiting
7 Relief from Sore 6 3 4.267 0.778
tongue
8 Relief from 7 3 4.633 0.78
Constipation
Fig. 2. Linear relationship between patient instance and prognosis.

Table 2
Linear regression for prognosis and its related symptoms.
Symptoms Regression Line Coefficient of
Determination

Epigastric Pain Y = 0.004 x +3.611 0.008

Flatulence Y = 0.013 x +3.542 0.091
Indigestion Y = 0.002 x +4.289 0.001
Improved appetite Y = 0.001 x +4.319 0
Stoppage of Vomiting Y = 0.003 x +3.618 0.006
Normalized Sore Tongue Y = 0.006 x +4.059 0.023
Recovery from Constipation Y = 0.003 x +4.535 0.005

Table 3
The Error estimates for peptic ulcer symptoms.
Relief of Linear Regression Gaussian Processes
Fig. 3. Linear relationship between patient instance and flatulence. Symptoms
Mean Absolute Root Mean Absolute Root
Error Squared Error Squared

Error Error

Epigastric Pain 0.7074 0.8403 0.7917 0.9754

Flatulence 0.6119 0.8217 0.5946 0.8059
Indigestion 0.8222 1.009 0.8418 1.0254
Appetite 0.7889 0.9877 0.7802 0.9992
Vomiting 0.6467 0.9723 0.674 0.8161
Sore Tongue 0.6921 0.8061 0.6988 0.802
Constipation 0.651 0.7997 0.6659 0.8001

Table 4
p-values for significant symptoms.
Symptom Regression Coefficient p-value∗

Flatulence 0.301662 0.02065

Prognosis 0.288097 0.026531

Fig. 4. Comparison of error estimates (mean absolute errors) by linear regres-
sion and Gaussian process.
which the stages of experiment are shown. This flowchart shows the
method based on mainly two components in the sequence - firstly the
linear regression aspect, followed by error handling contributed by a
Gaussian process. These are applied on the dataset, and treatment re-
cords were collected from the hospital as mentioned before. The figure
shows the iteration progress until the error is within threshold. Here
since our data size is small, not only is the error small, but the method
terminates after completion of all records for classification. The results
of this method are shown in Tables 2–3, using the open access software
tool Weka [10]. Weka is a software package written in JAVA code, and
is a common data mining tool for preprocessing, classification,
(*p < 0.05).
clustering, development of association rules, and visualization. Fig. 2
indicates the scatter diagram of the features in the patient dataset for
prognosis. Fig. 3 indicates features in the patient dataset for flatulence.
In both Figs. 2 and 3, the relationship is evident, irrespective of order of
patient instances shown on the X-axis. Both figures depict the range in
number of days for elimination of symptoms, and show the data points
with peaks and troughs for recovering from symptoms such as flatu-
lence, as well as for the overall prognosis. Fig. 4 compares error esti-
mates (mean absolute error, root mean square error) by linear regres-
sion and Gaussian process. to show the sensitivity of the obtained
model.
Table 1 shows the statistical description of the dataset for peptic
ulcer treatment, which is expressed as summaries of statistical

3
K. Appavoo and M.R. Krishna Rao
descriptions including the maximum, minimum, mean, and standard
deviation for the cohort of 60 patients. The range of number of days in
which the cure of symptoms takes place provides salient information.
Table 2 depicts the outcome of regression analysis to predict prog-
nosis, and another seven symptoms based on the treatment of peptic
ulcer for the selected cohort. This table demonstrates the nature of
fitting of the regression line for the dataset with observations X = {xi },
each xi being the symptom and y is the prognosis. Table 3 indicates the
error estimates for peptic ulcer symptoms. This is further to the Linear
Regression (LR) model, with usual standard error estimates MAE and
RSE are tabulated applying Gaussian processes. In this table we find
that the (GP) performance was better than simple LR. Moreover, it
shows minimum values for the attribute, i. e. flatulence. Furthermore,
all of the above tables show the absence of an outlier problem for this
dataset. Table 4 shows the p-values of significant symptoms, i. e.
flatulence and prognosis.
7. Discussion
Predicting the response to individual drugs based on the symptoms
has proved to be a statistically easier approach, even though the models
obtained may contain noise specific to the selected dataset, leading to
less accurate results with independent datasets. Therefore, more gen-
eralized analytical methods for improved prediction with larger data-
sets is proposed for a future project. To address the error minimization,
a Gaussian Processes would be useful, based upon probability theory, to
determine the nonlinear relationship between the attributes implied by
the covariance, since knowledge of one reduces uncertainty in the other
[11,12]. A similar work was reported by Koc et al., 2017 on bleeding
peptic ulcers [13]. Rezaei et al., 2014 have employed a Fuzzy inference
system to assess the severity of peptic ulcer presentation [14]. The re-
gression model described herein shows that [1,2], i. e. Flatulence and
Prognosis, respectively, are statistically significant according to the p-
value (Table 4), which is less than 0.05. For other symptoms, it in-
dicates that there is insufficient evidence in the sample dataset to
conclude that non-zero correlation actually exists. This predictive
model will assist physicians in the following way:
a. The physician can expect the relief of a particular symptom in a
patterned duration by treatment with Sirucinni uppu.
b. If this prediction fails for more than one symptom, the physician can
understand that the importance of more invasive diagnostic
methods without losing time. This can help in serving the patient
better to obtain an early remedy.
Ethical statement
The authors have abided by all ethical parameters while preparing
Informatics in Medicine Unlocked 15 (2019) 100169
the article.
Conflicts of interest
This is to declare that no conflicts of interest exist among the au-
thors.
Funding
The work is self-stipendiary and no external funding was availed.
Acknowledgements
The authors wish to acknowledge the assistance rendered by all in
the successful competition of the present work.
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