Ischochymia Due To Atony

In this condition the residue of chyme found in the stomach in the fasting state consists of some liquid and fine particles of food. Even if coarse particles of food (as, for instance, asparagus, spinach, rice grains not too well cooked, chestnuts, and the like) have been ingested on the previous day, the residue of these substances is not so very much pronounced, while in ischochymia due to stenosis of the pylorus it will be found that the entire quantity of such coarse particles of food, which undergo no changes in the stomach, will remain within the organ. In atony of the stomach the difficulty merely lies in a deficient peristalsis of the stomach, i.e., the contents are not sufficiently pushed toward the pylorus. But whatever reaches this outlet can pass without much inconvenience, whether it be very fine or whether coarser particles be present. This is quite different in stenosis of the pylorus, for here the main obstacle is the narrowness of the canal, which does not permit of the passage of coarser particles of food.

The peristalsis of the stomach, even if the muscles work with increased1 activity, is here without much avail.

As cases of ischochymia due to a weakened condition of the muscular action of the stomach are quite rare, the following case, which I have observed very recently, will not be without interest:

Patient H------, aged 46 years, had been suffering for the last three years with an intense burning sensation, beginning at the pit of the stomach and extending all the way up through the oesophagus to the pharynx. There was a feeling of pressure in the gastric region, which occasionally alternated with pains. Besides, the patient complained of belching of bad-smelling gases, which were very disagreeable, especially to his wife and immediate family. His appetite was fair, and constipation existed only in a slight degree. His weight had steadily decreased during the last three years, so that he had lost over fifty pounds within that period. The examination of the patient revealed that the stomach was quite enlarged; a splashing sound extended to about two fingers' width below the navel, and a succussion sound could be easily produced. The examination of the stomach in the fasting condition revealed the presence of a considerable quantity of chyme, which presented all the signs of marked decomposition (almost fetid odor, presence of sulphuretted hydrogen; microscopically, each specimen was full of micro-organisms, yeast cells, and sarcinae); free hydrochloric acid, however, was present in quite normal amounts.

After a thorough cleansing of the organ, the patient was told to partake of light (more liquid) food during the day, and for supper of some meat, a liberal amount of rice, not too well cooked, and some bread.

On the following morning the patient was again examined in the fasting condition. While some chyme was present in the stomach, the amount of rice found was very small indeed, so that it was rather difficult to recognize its presence with certainty. The result of this observation, combined with the points derived from the history of the disease (the symptoms steadily keeping on and slowly gaining in severity, no decided free intermissions of long duration), seemed to point to an atonic state of the gastric muscles, rather than to stenosis of the pylorus. The beneficial results of the treatment, which was based on this view (regulation of diet, four or five meals daily, interdiction of larger amounts of liquids, large doses of bismuth, with the addition of small doses of resorcin, and occasional lavage of the stomach), justified the conclusion that the diagnosis was correct. The patient after a few weeks felt much better, lost his burning sensation, while the stomach in the fasting condition was now found empty, and only after the ingestion of a very large supper the stomach on the following morning contained a small quantity of chyme, but not smelling badly.

After three months the patient bad gained twelve pounds in weight, and is steadily improving.