Definition

Chronic inflammation of the gastric mucous membrane, causing various disturbances in the act of digestion.

Pathological Anatomy

The mucosa is usually covered with a thick layer of tenacious mucus presenting a yellowish-gray or slate-gray color, while some parts may appear intensely red. The latter condition is frequently found in the secondary catarrh caused by congestion. The mucosa is frequently thicker than normally, and forms papillary projections, thereby causing the so-called etat mamelonni.

As a rule, the pyloric portion of the stomach is chiefly involved. The inflammatory process, however, may sometimes extend over the entire mucous membrane. In some instances the submucosa and muscularis may also undergo some changes, and appear either in a hypertrophied state or very much atrophied. Microscopically the glands often seem enlarged, sacculated, and dilated in cyst-like forms. The tubuli have lost their normal regular arrangement and show an atypical distinct ramification. The glandular cells appear granular and in a condition of fatty degeneration, and there is no longer any difference recognizable between the principal and parietal cells. An abundant small-celled infiltration is present which fills the interglandnlar spaces and pushes the glands apart. This small-celled infiltration is especially marked near the surface of the mucous membrane.

The superficial layer of the epithelium of the mucosa is frequently defective. The mouths of the glands are very often filled with a pale mucous mass, which projects against the lumen without any enclosing membrane. According to Ewald,1 there is a condition of mucous catarrh in which the degeneration may be observed to extend down to the base of the glands, so that in place of the ordinary principal and parietal cells we find cells in the most varied stages of mucoid degeneration. This condition is especially found in the pyloric region. Some cells may be found which are still intact, the mucus filling only a small part of them, while the rest of the cell is occupied by granular protoplasm and a large nucleus. In others the mucus occupies the greater part of the cells and crowds the protoplasm and the flattened nucleus against its base; in still others the cell membrane has ruptured, and the mucus has escaped into the lumen of the duct of the gland. This mucoid degeneration Ewald found only in specimens which had been placed while still warm in alcohol. In older specimens the condition above described could not be discovered. In a patient with cancer of the pylorus, I had the opportunity to find in the wash-water a small piece of the gastric mucosa.

It was placed in alcohol at once, and the microscope revealed a beautiful picture of mucoid degeneration (see Fig. 34).

The inflammatory process after existing for a long period may at the end lead to a total destruction of the glandular layer of the entire organ, thereby causing a condition which has been termed atrophy of the stomach or anadenia ventriculi (Ewald). Two different processes ultimately effect this condition.

1 Ewald: l c, p. 318.

The first consists in a fatty degeneration and destruction of the gland, the process progressing from the surface of the stomach inwardly. While in the early stage no glands are found on the surface of the mucosa, there still exist glandular cysts situated near the submucosa. Later on even these glandular cysts disappear, and the whole mucosa consists almost entirely of round cells. According to Ewald, this process is especially met with in those instances in which the entire organ is more or less dilated and the walls thin. The submucosa is then also partly changed, the muscular layer being much thinner.

The second process takes its origin in the submucosa, and progresses from the deeper layers to the surface of the stomach. In this instance the fibrous elements play the greater part. The inflammatory process causes the formation of fibrous tissue, which spreads around the glands and partly constricts them. The glands are also ultimately destroyed and their place taken up by fibrous tissue. As a rule this condition is found in stomachs which are much smaller than usual, and present a thickening of their walls. The size of the organ in such instances may be reduced to that of a big pear, and the walls may attain a thickness of about 1 to 2 cm. Brinton1 has termed this condition "cirrhosis ventriculi," while the French designate it "sclerosis ventriculi." This condition of cirrhosis ventriculi, however, may be associated with the first-described process, as the following drawing of a case I have observed clearly illustrates.

1 W. Brinton: "Diseases of the Stomach".

Etiology

Chronic gastric catarrh is more frequently met with among men than among women.

It is often caused by an irrational mode of living. Fast eating, resulting in imperfect mastication of the food; overloading the stomach with too large quantities of food; highly spiced dishes; ice-cold drinks - all these tend to irritate the stomach, and to cause a catarrhal condition of the organ. In this country ice water and fast eating are the two principal causes of the so-called "American dyspepsia." Tea and coffee taken in too large quantities are also said to cause this trouble. Alcoholic drinks, especially the stronger ones, as whiskey or liquors (among them also stomach bitters), and the abuse of tobacco (smoking and chewing, especially the latter) also frequently give rise to this affection. But even in people leading a regular life chronic gastric catarrh may develop, either after frequently repeated attacks of the acute form or after the recovery from very severe infectious diseases. Thus typhoid fever is frequently found to be the origin of the affection. An unhealthy condition of the mouth, and more so of the teeth, is liable to produce gastritis; for in these instances the food on the one hand cannot be chewed thoroughly, on the other hand it becomes impregnated with products of decomposition originating from decayed teeth, and in this way produces an undue irritation of the gastric mucous membrane.

Chronic gastric catarrh is moreover found as a secondarv disorder in association with many other chronic diseases; thus, for instance, all kinds of pulmonary and cardiac affections, liver and kidney troubles, are frequently found to be complicated with chronic gastritis. Likewise some constitutional diseases, as for instance gout and diabetes, are frequently combined with gastritis.

Symptomatology

As a rule the disease develops very slowly. The initial symptoms are not well marked. After the condition has lasted for a longer period of time the disturbances become more pronounced, and a train of many varied symptoms is present. The patients frequently complain of an abnormal taste in their mouths. They describe it either as salty or as pappy, in a few instances as sour. The appetite is ordinarily diminished, or, if present, the feeling of satiation appears after a few morsels of food. After meals there is a sensation of fulness in the gastric region, and the patient feels oppressed. This feeling, if present in a higher degree, sometimes gives rise to symptoms of quite an alarming nature. Thus the patients complain of palpitations of the heart and shortness of breath (asthma dyspepticum). In some instances again there appears a dizzy feeling, which is occasionally so severe that the patient cannot occupy a standing position but has to sit down or lie down. The oppression experienced is relieved by belching, but the latter may occur so frequently as to greatly annoy the patient. In fact, belching constitutes, one of the most frequent symptoms of chronic gastric catarrh.

As a rule, a quantity of odorless gas is brought up by the act of belching, although in very rare instances it may have an unpleasant odor.