Prognosis

The prognosis of a genuine chronic gastritis is not bad. A rational treatment succeeds, as a rule, in either curing or materially improving the patient. The ailment is, however, by no means of an indifferent nature; in a certain measure we can say that the trouble is the more serious the less secretion there is in the stomach. Very frequently we are not able to bring back the stomach to its normal state of secretion, even if we succeed in combating the subjective symptoms. Exacerbations and relapses are also liable to occur. For these reasons chronic gastritis must be considered as a tedious affection.

Treatment

The regulation of the diet is of prime importance in the treatment. The dietary to be selected will depend upon the severity of the symptoms. At the beginning, therefore, a light diet will be called for. The patient should partake of four or five meals daily. The articles of food should be given largely in liquid and semi-liquid form; viz., milk, kumyss, mat-zoon, barley, oatmeal, and rice soups prepared in milk; chicken soup, with an egg beaten up in it; softboiled eggs; mashed potatoes; scraped meat, raw or broiled; toasted bread, and also French white bread (not too fresh); butter; tea and cacao. The quantity of nourishment for each meal should neither be excessively large nor too small.

Ewald's bill of fare for chronic gastric catarrh is as follows:

Eight o'clock - 150-200 gm. of tea with 75-100 gm. of stale white bread, toast or zwieback.

Ten o'clock - 50 gm. of white bread, 10 gm. of butter, 50 gm. of cold meat or ham, occasionally one glass of light wine or one-third litre of milk.

Two o'clock - 150-200 gm. of water, milk, or bouillon of the white meats, 100-125 gm. of meat or fish, 80-100 gm. of vegetables, 80 gm. compot.

Four or five o'clock - one-fourth to one-third litre of warm milk (occasionally mixed with cacao or coffee).

Seven to eight o'clock - 200 gm. of soup or pap, 50 gm. of white bread, 10 gm. of butter.

Occasionally at ten o'clock - 50 gm. wheaten bread (biscuits or zwieback), one cup of tea.

My own bill of fare for the first week of treatment is as follows:

The patient having been kept on this diet for a week or two, the diet must be gradually changed to one suitable for the lighter forms of chronic gastritis. Here the following rule will apply: The diet should correspond as nearly as possible to the common mode of living. In this way the distribution of the meals should be arranged according to the customs prevailing in those places in which the patients live. All foods derived from the vegetable kingdom should be given in large portions, while the quantity of meat should be somewhat limited. In order to permit the patient to have a greater variety in his food, it is best not to point out a few articles he should eat, but to mention only those he should avoid. Forbid meat with very tough fibres, meat from too old animals or too fresh meat (right after slaughtering), meat that contains too much fat, like pork; forbid sausages, lobster, salmon, chicken salad, mayonnaise, cucumbers, pickles, cabbage, strong alcoholic drinks like liquors. It must be impressed upon the patient to masticate the food thoroughly, to eat slowly, not to think of business during meals, and to stop eating before the sensation of satiety appears.

The latter advice is only necessary in persons who are accustomed to high living.