Synonyms

Atrophy of the stomach; anadenia ventriculi; phthisis ventriculi.

Definition

This term embraces a class of cases in which there is a permanent absence of gastric secretion.

General Remarks

In 1892 I1 suggested the term "achylia gastrica" for those conditions in which the stomach apparently secretes no juice and in which clinically the diagnosis of "atrophy of the gastric mucosa" seems to be justifiable. In a paper referring to this subject I endeavored to show that cases of achylia gastrica and cases of pernicious anaemia ought to be kept strictly apart. Whereas the latter, as a rule, end fatally, the former do not necessarily endanger the life of the patient. As a proof of this view I described a case of achylia gastrica which I had under observation for four years and whose condition had meanwhile somewhat improved, and another case in which the history given by the patient made it probable that the stomach had persisted in this state of juicelessness for forty years. In this case there were no subjective symptoms present and the patient used to partake of the heaviest food with perfect impunity. In all these cases the small intestine acts vicariously and completely replaces the lack of digestion of the stomach.

1 Max Einhorn: Medical Record, June 11th, 1892.

In regard to the literature of "atrophy of the gastric mucosa" I refer to the excellent paper of S. Fenwick,1 who first described this condition in cases of pernicious anaemia, and to the work of Lewy,2 Ewald,3 Henry and Osier,4 Kinnicutt,5 Nothnagel,6 and George Meyer.7

In all cases described by these writers (mostly pernicious anaemia) the autopsy showed the disappearance of the gastric glands. Henry and Osier have given various characteristic drawings illustrating the microscopic picture of this condition.

In most cases of atrophy of the stomach mentioned in literature the sickness in question is one in which all the functions of the stomach are disturbed and which gradually leads to death. There have been described, however, a few cases of atrophy of the stomach in which the clinical symptoms, or, more correctly, the chemical analysis of the stomach contents led to the above diagnosis, which by no means seemed to present such a severe irreparable disease. In these cases no autopsies could be made, and atrophy of the stomach, although it must here be conjectured, is not as yet proven to exist. Cases belonging to this latter group have been described by Grundzach,1 Ewald,2 Wolff,3 Jaworski,4 Boas,5 Rosenheim,6 Litten,7 and myself.8 For these cases the name achylia gastrica seems to be best adapted.

1 S. Fenwick: "Atrophy of the Stomach." The Lancet, July, 1877.

2 B. Lewy: Berliner klin. Wochenschr., 1887, No. 4.

3C. A. Ewald: ibid., 1886, No. 32.

4Henry and Osier: American Journal of the Medical Science vol. 91, 1886, p. 498.

5F. P. Kinnicutt: American Journal of the Medical Sciences, vol. 94, 1887, p. 419.

6Nothnagel: Deutsch. Arch. f. klin. Medicin, Bd. xxiv., Heft 4 und 5.

7 George Meyer: "Zur Kenntniss der sogenannten 'Magen-atrophie.'" Zeitschrift fur klinische Medicin, Bd. xvi., p. 366.

The recent literature on cases of pure achylia gastrica (not complicated with pernicious anaemia) is not very extensive. Simultaneously with my article on "Achylia Gastrica" Ewald 9 published a paper entitled: "A Case of Chronic Disability of Gastric Secretion (Anadenia Ventriculi?)." Ewald's views are in perfect accord with mine. The patient reported in the paper had been observed by Ewald for two and a half years. Although this patient improved considerably in every respect and gained forty-two pounds in weight, the chemical examination of the gastric contents showed a total lack of juice.

In this country Allen A. Jones10 has described under the name of "Gastric Anacidity" four rases belonging to this class of affections. Recently D. D. Stewart' has written a very valuable paper on the same subject. Martins and Lubarsch" have just published a book on this disease.

1 J. Grundzach: Berl. klin. Wochenschr., 1887, No. 80.

2 C. A. Ewald: "Ueber das Fehlen der freien Salzsaure im Magen-inhalt." Berl. klin. Wochenschr., 1887, No. 80.

3 L. Wolff: ibid.

4 Jaworski: Wiener medicinische Wochenschr., 1886, Nos. 49-52.

5 I. Boas: Mtinchener med. Wochenschr., 1887, Nos. 41 und 42. 6Rosenheim: Berl. klin. Wochenschr., 1888, Nos. 51, 52.

7M. Litten und Rosengart: Zeitschr. f. klin. Medicin, 1888, p. 573.

8 Max Einhorn: "Ein Fall von continuirlichem Magensaftfluss und ein Fall von vollstandigem Fehlen der Salzs&ure im Magen." New Yorker medicinische Presse, September, 1888.

9 Ewald: Berliner klin. Wochenschr., 1892, Nos. 20 und 27.

10 Allen A. Jones: New York Medical Journal, May 27th, 1893, p. 573.

Morbid Anatomy

There exist but few cases of achylia gastrica in which autopsies have been made.

One case, observed by me, showed a complete atrophy of the gastric tubules (see p. 188, Fig. 54).

1 D, D. Stewart: American Journal of the Medical Sciences, No-vember, 1895.

2F. Martius and O. Luliarsch: "Achylia, gatrica, ihre Ursachen und ihre Folgen," Leipzig und Wich, 1897.

As to the question whether in all cases of achylia gastrica there necessarily exists an anatomical lesion (atrophy of the glands) or not - i.e., whether cases of achylia might not perhaps occur in which the gastric mucosa is not much altered, I must say from my own experience that the latter is frequently the case. This is the reason why a repair of this condition is occasionally observed.1

Etiology

According to the views generally entertained, achylia gastrica is a sequel to certain severe chronic catarrhal conditions of the stomach. The more recent text-books on gastric diseases (Ewald, Boas, Bouveret) discuss this affection under the head of "Gastritis Glandularis Chronica." I certainly believe that such an origin of achylia gastrica is sometimes traceable. The cases of chronic gastric catarrh in which the acidity is pretty low (10 to 20), and in which no free HC1 exists, hut both the biuret reaction and rennet are present, speak in favor of this view. They represent, so to say, the prodroinic stage of achylia gastrica. Notwithstanding this it seems to me more than probable that the affection in question may develop also in some other way (in consequence of nervous disturbances). In such instances the glandular layers of the stomach need not necessarily be greatly altered, although it appears probable that after a long persistence of inactivity of the glands these may begin to atrophy.

1 Max Einborn: "A Further Report on Achylia Gastrica." Medi-cal Record, July 8th, 1895.

Symptomatology

With regard to their subjective complaints patients with achylia gastrica may be divided into three groups:

1. Patients without any subjective symptoms whatever and enjoying perfect euphoria;

2. Patients presenting a variety of gastric symptoms associated with mild intestinal disturbances;

3. Patients without any apparent gastric symptoms, but with severe and obstinate intestinal disturbances.

Cases belonging to the first group are quite rare. I therefore do not deem it superfluous to describe here such a case without any gastric or intestinal symptoms, which possesses the further interest that it was complicated with rumination.