Chronic gastritis may result from an improperly managed acute case or from repeated attacks of acute gastritis, but it usually develops gradually, the result of faulty habits, of which the regular and excessive indulgence in alcohol is the commonest. The habit of bolting food may bring it about, also insufficient mastication of the food because of lack of teeth or poorly-fitted false plates. The constant swallowing of pus from decayed teeth, infected gums, or diseased tonsils, is responsible in some cases. Insufficient water with the meals it is believed will cause it. An excess in condiments is a frequent cause.
The digestive juices normally depends on nerve influence and the effect of the nerves on the other activities of the digestive apparatus. Suppose a person should suffer a permanent loss of appetite through emotional causes, the loss of the stimulating effect of the appetite juice on the secretion in the stomach would result in lessened secretion and in time atrophy of the stomach secreting cells. Emotional disturbances also appear to have a direct inhibiting effect on these cells. In the absence of other responsible agents, a complete breakdown of the secretory apparatus of the stomach may thus be affected, due entirely to emotional causes.
This condition is not strictly an inflammatory process but the result is the same as though it were brought about by alcohol or the other irritants mentioned. Technically, it is called achylia (absence of gastric juice). It does differ from true gastritis somewhat in not being dependent on local irritation. A stomach so affected can be reclaimed by careful treatment. This treatment includes the removal of the cause of the nervousness. This is really the most important factor in such a treatment.
The symptoms of chronic gastritis are those of ordinary functional indigestion. Appetite is usually lacking. Such stomachs are nearly always deficient in tone and we therefore have pressure sensations and gas rumbling, rarely nausea and very rarely vomiting. If vomiting does occur, the vomitus is usually tasteless. Most of these symptoms are due to the nervousness that is back of the trouble and the diagnosis cannot be made on them alone. It requires a physician’s examination and the employment of various stomach tests. Mucus in a vomitus and a tasteless vomitus strongly suggest it.
In the ordinary forms of gastritis, those due to long continued irritations, etc., the symptoms are similar. The vomiting is perhaps more of a feature in these cases and there is more mucus expelled. The vomitus may be acid in the early stages but later becomes tasteless due to the damage of the secreting cells. This vomiting is not constant and it may occur only after heavy or unusual foods or alcoholic excesses. The disease runs a chronic course. So long as the patient is content to eat the foods that do not irritate, he suffers very little inconvenience, but let him overstep the rules laid down for him by his doctor, he will be made aware of his trouble in an attack of indigestion.
Early morning retching is a characteristic of alcoholic gastritis. This is due largely to an irritable condition of the throat. The rapid and excessive smoking that these people usually indulge in, leads to this irritability of the throat. The alcohol itself acts in a like manner, particularly if it is swallowed undiluted.
There are several stages of true gastritis - first, the acid stage in which hyperacidity obtains and the symptoms are those of acidity. The appetite is increased. Food is craved because it temporarily relieves. Soda gives relief. Pressure in the stomach after meals is common. If the patient vomits, this occurs soon after the meals and the vomitus is extremely sour. This stage may occupy years. If neglected or improperly treated, it will run into the second stage, in which the gastric cells have begun to degenerate. The appetite then begins to decline and it is found that coarse foods cannot be eaten without causing some disturbance. Vomiting is not common in this stage but if it does occur, mucus is expelled with the vomitus. Pressure after eating and the other common symptoms of indigestion may or may not be complained of. Usually the symptoms are insignificant compared to those of the purely nervous types of indigestion.
The latter stages of the chronic gastritis are characterized by complete atrophy of the secreting cells. The appetite is gone. The symptoms are similar to the indigestion symptoms like pressure after meals, abdominal gas with some distention. Irregular bowel function with occasional looseness of the bowels. Undigested meat fibers and other food elements are found in the feces. The patients usually suffer some loss in weight because of undernourishment.
The preventive treatment of this disease is or should be obvious. Teeth, tonsils, and the nose and throat should be watched for evidence of disease. Gluttony is to be condemned. The stomach and intestines will do their work efficiently if given half a chance, but there is a limit to what they will stand. The steady drinking of alcohol, particularly the spirits, cannot be indulged in indefinitely. Soda should not be taken without doctor’s consent. It may give temporary relief from the symptoms of chronic gastritis, but should the stomach acid be low, and it is in most of the cases, it will only increase the trouble and postpone the cure.