Synonyms

Chronic continuous flow of gastric juice: Reichmann's disease.

Definition

Reichmann,1 in 1882, described under the above name a disorder which is characterized by a constant secretion of gastric juice, even in the absence of food in the stomach. Considerable quantities of gastric juice can be withdrawn from the stomach in the morning, even in the fasting condition.

General Remarks

In describing this new disease Reichmann in 1887 mentioned that he had observed sixteen cases. An exact scientific diagnosis had been made, however, only in six of them. "In the remaining cases," says Reichmann, "I was able to find in the stomach in the morning in the fasting condition a large quantity of a liquid containing hydrochloric acid and pepsin, and exhibiting digestive properties, but also containing much peptone and remnants of amylaceous food".

Among the six cases which Reichmann considered as typical of gastrosuccorrhoea chronica, 1 think that only one (Case 3) deserves this name, for the remaining five, aside from the constant secretion of gastric juice, presented other important lesions of the stomach, which in all probability were rather the cause than the effect of the constant gastric flow. In all the cases described by Reichmann, except in Case 3, the stomach in the fasting condition contained a considerable quantity of liquid, consisting of gastric juice, and containing only amylaceous food remnants. When the stomach had been washed out on the previous night, and the patient had abstained from food or drink, the stomach in the morning nevertheless contained clear gastric juice. These cases are then undoubtedly cases of dilatation of the stomach, or, more correctly speaking, of stenosis of the pylorus, in which hypersecretion must be considered as a concomitant factor. Reichmann, and following him, especially the French writers Bouveret,1 Debove and Remond,2 and among the Germans Riegel,3 have laid too little stress upon the distinction between the constant flow of gastric juice and dilatation of the stomach due to stenosis of the pylorus.

On this account the picture given by these authors of the true gastro-succorrhoea chronica bears a closer resemblance in many points to that of dilatation of the stomach than to the picture of the affection in question. Inasmuch as the treatment of cases of stenosis of the pylorus is in most essential points different from cases of gastro-succorrhoea (I need only mention that the most rational treatment for the former is a surgical one), it is absolutely necessary strictly to differentiate between these two conditions.

1 Reichmann-. Berl. klin. Wochenschr., 1882. No. 40; 1884, No. 48, and 1887, No. 12.

About two years ago Schreiber,4 of Konigsberg.

1 Bouveret: "Traite des Maladies de l'Estomac." 2 Debove et Reniond: "Les Maladies de l'Estomac." 3Riegel: Deutsche med. Wochenschrift, 1803, Nos. 31 und 32. 4Schreiber: Deutsche med. Wochenschr., 1893, Nos. 29 und 30, published an extensive paper in which he expressed doubt as to the existence of the new disease, regarding all the cases described by Reichmann as cases of dilatation of the stomach with stagnation of food. Shortly afterward two other important papers appeared with reference to this question. Riegel defended Reichmann's views, while Martius1 was inclined to favor Schreiber's opinion. Whether Schrei-ber's view, that the stomach normally secretes gastric juice even while in its empty state, is correct or not, is a question that is quite difficult to decide, although I am personally of the opinion that when there is no food in the stomach there is no secretion. But leaving aside this question about the physiology of the stomach, there is no doubt that, as a rule, the stomach in the fasting condition does not contain any considerable quantity of gastric juice.

Whenever larger quantities are found the stomach must be regarded as affected.

Etiology

Gastrosuccorrhoea chronica is met with much more frequently in men than in women. In some instances there is present besides this affection some other functional neurotic disturbance. In three of my cases the latter was very marked. Thus one of these patients complained of a burning sensation all over his limbs, which lasted for three months and then suddenly disappeared. Like hyperchlor-hydria, gastrosuccorrhoea seems to arise from great mental worry or strain.

Symptomatology

After a more or less prolonged period of different dyspeptic disturbances which are similar in character to those caused by hyperchlorhy-dria, there appears a pronounced sensation of pain several hours after and shortly before meals. Very soon vomiting supervenes as a new symptom. At first it occurs only occasionally, but constantly grows more frequent until at last there may be one or several vomiting spells every day. The vomiting appears most frequently soon after breakfast, sometimes also after supper. In only a few cases does it occur in the night, about two or three o'clock, preceded by a long and severe attack of pain. The vomited matter is always very acid and more or less liquid. The night vomit consists, as a rule, of a clear liquid containing hardly any food.

1 Martius: Deutsche med. Wochenschrift, 1894.

The appetite is generally increased, although there are exceptions to this rule. In some cases periods of extreme hunger alternate with periods of pronounced anorexia. In most cases the sensation of thirst is greatly increased. In all of my cases constipation was marked. In some there was loss of weight, but none of my patients was emaciated in any great degree.

Diagnosis

Although the symptoms described might suggest the presence of gastrosuccorrhoea in certain cases, the exact diagnosis can be made only by a repeated examination of the stomach in the fasting condition. By inserting the tube into the stomach, and telling the patient to exert some pressure with his abdominal muscles, more or less liquid (60 to 100 c.c.) is obtained from the stomach. This contains no food particles, but exhibits all the properties of the gastric juice. It may look greenish from the admixture of bile, but this is not an important sign. The filtrate, as a rule, shows a somewhat increased degree of acidity. It never contains any starchy products (absence of erythrodextrin, achroodextrin, and sugar).