Acute Gastritis

The most important symptom in acute gastritis is nausea and vomiting. Following the general principle stated above in all acute conditions where nausea and vomiting are symptoms, there should be a complete cessation of all ingestion of foods for a period of two or three days. The patient's thirst may be slaked either by ingestion of very small amounts of pure cold water taken every thirty minutes, or if this is not borne by the stomach, enemata of normal saline solution, as described in a previous chapter, may be used.

The dryness of the mouth and throat may be relieved by taking sips of cold water or small bits of ice into the mouth, but permitting none of the liquid to pass into the stomach. After two or three days it will be found that a small amount of water may be swallowed without causing any nausea. From that time on very moderate ingestion of liquid foods may be allowed, not more frequently than once in two hours, beginning with peptonated or limewater milk, or egg lemonade, giving not more than one or two ounces at intervals of two hours during the first day, increasing the quantity in three-hour intervals the following day, and gradually, as the days go by, increasing both in quantity and interval, passing gradually from liquid into semi-solids, and finally into solid foods, and three square meals a day. It goes without saying that in acute gastritis, even after the stomach has proven itself able to retain and digest solid food, one should avoid the ingestion of anything that can irritate the stomach, or any food difficult of digestion. All condiments, alcoholic drinks, strong tea and coffee, and vegetables possessing a large proportion of cellulose, are contraindicated until health is thoroughly established.

Chronic Gastritis

This condition of the stomach differs from acute gastritis in several important respects. While acute gastritis is strictly a functional disorder, the chronic gastritis is associated with pronounced organic change of the stomach, taking the form of a thickening of the mucous membrane. Chronic gastritis begins gradually and can usually be traced in its origin to the habitual ingestion of irritating substances. It is probable that in the vast majority of cases the irritating substance is alcohol. Chronic gastritis is more frequently associated with chronic alcoholism than with any other condition. When the case comes to the physician and dietitian there is already a serious disturbance of nutrition. The absolute contraindication of any further ingestion of alcohol is the first thing to be recognized. The stomach needs water. Swallowing of water is very likely to be associated with nausea and vomiting; this may be avoided in a large part by gastric lavage. The technic of gastric lavage has already been described above. It should be done at least once each day, preferably in the morning before breakfast. The foods first presented to these patients should be predigested proteins, mixed with fats and sugars. The food that most nearly fulfills this requirement is peptonized milk. Such food leaves the stomach little to do. The peptonized milk does not form curds and passes presently through into the duodenum, where the digestion of the fat is accomplished and the lactose is split up, after which it is ready for absorption as to all of its constituents. After two or three days of the use of peptonized milk, milk and limewater may be presented, followed by milk diluted with barley water or oatmeal water. From these liquid foods gradual variety and change may be introduced through the use of meat juices, broths thickened with thoroughly cooked cereals, egg lemonade, and delicate custards and gelatins, gelatin and whipped cream, and so on through the list of easily digested semi-solid foods merging into the easily digestible solid foods. As the semi-solid and solid foods are introduced into the dietary the greatest care should be observed in their mastication. The perfect mastication and insalivation of every mouthful should be insisted upon. If the patient does not know how to accomplish this, then he should be taught. Two general rules should be observed as the patient begins the use of semi-solid and solid foods - namely, first, to eat small amounts; second, to eat regularly. Among the things that should be rigidly excluded from the diet, the following may be named: Coarse vegetables, candies, pastries, fried foods, as fried potatoes or fried eggs, cakes, puddings, spices, condiments, alcohol, hard-boiled eggs, lobster, and any substances against which the patient is known to have an idiosyncrasy.

In some cases of gastritis there is a profuse secretion of mucus, in others a profuse and continuous secretion of hydrochloric acid, in others a diminished secretion of hydrochloric acid, and still others a wholly suspended secretion. These four special phases of chronic gastritis may merge one into the other. They are technically called mucous gastritis, hyperchlorhydria, hypochlorhydria, and achlorhydria.

Mucous gastritis, characterized by an abnormal amount of mucous secretion in the stomach, is best treated by gastric lavage, and this is most effective when done the first thing in the morning before any food is taken. After a short period of the lavage through the stomach-tube it may be possible to accomplish a natural lavage through the ingestion of a pint of cold water one hour before breakfast. This differs essentially from the artificial lavage in that it forces the mucus and water into the intestinal tract instead of siphoning it out. Natural lavage is always to be preferred to artificial lavage, when it is possible to get the normal result - that is, when the contents of the stomach actually pass into the duodenum within an hour. It goes without saying that no food should be taken into the stomach until this has been accomplished. The test as to whether or not the stomach is empty one hour after the drinking of a pint of cold water can be made by introducing a stomach-tube filled with water and clamped until the end of the tube is within the fundus of the stomach. By lowering the outer end of the tube following the method of siphoning in artificial lavage, the contents of the tube, together with any liquid in the stomach, will be siphoned out. If the stomach is empty only the contents of the tube will be returned, together with perhaps a few drops of just secreted mucus. If a quart or more of slimy mucus is siphoned off, that will be a proof that the natural lavage has not run the intended course and that the stomach has not been emptied. After the morning lavage, whether artificial or natural, the breakfast may be taken. The same general dietetic regime will be followed in mucous gastritis as in acute gastritis just described.

Hyperchlorhydria is characterized by greatly increased secretion of hydrochloric acid. While it is a form of gastritis that may follow the excessive use of alcohol, still it is also caused by overeating, by improper mastication, or by the interference of digestion through worry, nervous shock, or fatigue. Some physicians give large quantities of proteins such as raw or soft-boiled eggs, or lean meat, with a view to the using of all the hydrochloric acid in its combination with the proteins, to form acid albumin, the idea being that the acid albumin thus formed is less irritating to the mucous membrane of the stomach than the free hydrochloric acid. While this is quite true, it is also true that the ingestion of a distinctly protein diet serves as a stimulus to the secretion of not only the acids but pepsin, as has been amply demonstrated in the recent work of Pavlow. In order to avoid the stimulating influence of the presence of a large amount of proteins in the stomach, a more rational dietary would be one in which the three organic foods have practically their normal balance. During the period of hyperacidity, the ingestion of milk diluted with lime-water, or with alkaline effervescent mineral water, may be used for the first few days of the dietetic treatment. From this initial treatment the diet may pass through gradations of semi-solid and solid foods, following the same general principles as outlined under Chronic Gastritis. In the case of complete loss of appetite, attended with nausea, when food is taken under protest, forced feeding or gavage may be followed in this ease as in a similar condition in the consumptive. The same care should be taken in these cases as in chronic gastritis to avoid all such irritating foods as those named under Chronic Gastritis.