Synonyms

Hyperacidity; hypersecretion.

Definition

The term hyperchlorhydria is applied to a condition in which the gastric secretion is mora acid than normally and richer in ferments. Frequently the quantity of juice is also increased, but it is secreted only during the period of digestion.

General Remarks

-While the older writers were acquainted, to a certain extent, with digestive disorders attended with hyperacidity of the gastric juice, it is but quite recently that these conditions have been thoroughly studied and placed on an exact scientific basis. Formerly it was thought that in most disturbances of the stomach the gastric secretion was deficient. Nowadays, since the publications of Riegel,2 Reichmann,3 Jaworski and Glusinski,4 Ewald5 and others, we know that in almost one-half of all the patients suffering with digestive disorders the gastric juice is rather increased.

1 This heading comprises affections in which either the secretory or the motor function (prochoresis) of the stomach is at fault, forming the principal symptoms. Anatomical lesions here are not always present and if present are often of various kinds.

2Riegel: Zeitschr. f. klin. Med., Bd. 11 and 12.

3Reichmann: Berl. klin. Wochenschr., 1882, No. 40; 1884, No 48; 1887, No. 12.

4 Jaworski: Zeitschr. f. klin. Med., Bd. 11, Heft 2 und 8.

5 Ewald: /. c.

According to my own experience, the gastric disorders accompanied with hyperchlorhydria form more than one-half of the number of patients troubled with digestive affections. With reference to this point the following table, which I published in the Medical Record of November. 1895. may be of interest:

Table Of Private Patients Whose Gastric Contents Have Been Analyzed During 1889 To 1895

Thus more than one-half of the cases showed a hyperacid state of the gastric juice.

Whether hyperacidity should be considered as a disease sui generis or not, is difficult to decide. Hyperacidity certainly describes only one symptom, showing that the secretory function is increased without pointing to any definite anatomical lesion; but this symptom maybe of the greatest importance, and very often covers the whole ground upon which is based the subjective suffering of the patient and the rational treatment at our command. That is the reason why I think it best to discuss hyperchlorhydria in a special chapter.

Does hyperchlorhydria always give rise to digestive disturbances and other symptoms? In order to answer this question it will be best to determine more exactly where hyperchlorhydria begins - i.e., to what degree of acidity we may apply this term. According to the experience of Ewald and others, to which I can add my own, the degree of acidity of the gastric contents about an hour after Ewald's test breakfast varies, as a rule, in healthy people between 40 and 60. A degree of acidity of 70 and above is therefore considered as hyperacidity. The above question will now be put in the following way: Must people with an acidity of their gastric contents of 70 and above always present morbid phenomena? To this I must answer in the negative. From a very large experience, I can assert that we occasionally meet with persons whose degree of acidity of the gastric contents is as high as 100 and even more, without producing any disturbances whatever. This condition need not even be a transient one, but may last for years and still cause no discomfort. This, however, is not the rule, and the greater number of persons with a hyperacid juice are not free from disturbances, but rather present a very characteristic train of symptoms.

We speak of a pathological hyperchlorhydria whenever this condition is associated with subjective complaints.

Etioloyy

As has been just stated, hyperchlorhydria is of very frequent occurrence. It is met with chiefly in adults, although neither the young nor the old are exempt. In the majority of cases its origin may be traced either to a psychological cause, such as grief or worry, or to mental overwork. It is, as a rule, more frequent among the wealthier and more educated class of people, as lawyers, bankers, etc., although hyperchlorhydria may be met with also among the poor. But in addition to this so-called reflex action of the brain as an etiological factor of the disease, there may also be direct causes; thus, for instance, the habit of taking highly spiced dishes, much ice water, and strong alcoholic drinks is liable to produce this trouble.

Symptomatology

This disorder is usually characterized by a gradual development. At first the patient experiences an uneasy sensation about two or three hours after dinner. Later this changes into a feeling of distress in the epigastric region, occurring about two hours after each meal, instead of after dinner alone. The pain lasts for an hour or two, or even three, and then disappears. Very often pyrosis accompanies the pain and occasionally regurgitation or water brash takes place. The patients, as a rule, can ease their pain by taking some nourishment, especially one that is rich in albumin; thus the white of an egg, milk, or meat is capable of dispersing the pain. It also disappears after the ingestion of some alkali, as Vichy water or bicarbonate of soda. The appetite is ordinarily not diminished but frequently rather increased. Thirst is generally enhanced. The bowels in most cases are constipated.

The composition of the food is frequently of significance with reference to the character of the pains, which are less intense in people partaking of large quantities of meat and eggs, while they are much more severe in persons living on a chiefly vegetable diet.

Besides the attacks of pain, patients affected with hyperchlorhydria very often suffer from severe headache or attacks of dizziness, which may appear either independently or accompanied by gastric pains. The patients, as a rule, do not lose in weight except in some rare instances, in which a faulty and insufficient diet has been maintained for quite a long time.