Synonyms

Gastroxynsis (Rossbach); periodic continuous flow of gastric juice.

Definition

Gastrosuccorrhoea continua periodica is a condition characterized by the acute appearance of a constant secretion of gastric juice giving rise to attacks of vomiting and severe pains.

General Remarks

Organic affections of the peripheral or central nervous system are present in some cases of this disorder, although it may occur in persons who are apparently free from nervous troubles. Reichmann l was the first to call attention to the periodic continuous flow of gastric juice; a few years previously Rossbach 2 had described under the name of gastroxynsis a nervous affection of the stomach, which consists in a sudden appearance of severe headaches accompanied by gastric pains and vomiting of very acid chyme or gastric juice. In accordance with Boas, I consider gastroxynsis and gastrosuccor-rhoea continua periodica to be one and the same affection, and do not think they should be treated under different headings.

Symptomatology

In the midst of perfect health a sensation of discomfort is experienced in the gastric region, which is associated with restlessness. Soon afterward the discomfort changes into a rather painful sensation, and nausea appears. The patient is compelled to occupy a recumbent position. The symptoms just described continue or rather increase in severity, and in about an hour or two the nausea ends in vomiting of a large quantity of gastric contents. The patient may now feel a little relieved for a short time, but soon the same symptoms return. The appetite is entirely lost and instead there is extreme thirst. The more the patient drinks the more, as a rule, he has to vomit. If he abstains from drinking, the vomiting is less frequent, but persists nevertheless. Thus, as a rule, in the middle of the night or early in the morning, the patient has to vomit a large quantity of a watery liquid which is very acid in character, and either quite clear or greenish from the admixture of bile. If this liquid be examined it will be found that free hydrochloric acid is present in large quantities, as are the ferments (rennet and pepsin). No food particles can be discovered in the fluid. It consists of either clear gastric juice or gastric juice with admixture of a little bile.

After such an attack frequently a constant desire to vomit persists, and the patient suffers from very violent and painful retching. Often a quarter of an hour after the last paroxysm, the patient's efforts to vomit cause a small quantity of clear yellow bile to be ejected. Even if the patient absolutely abstains from all kinds of food and drink, a few hours later a largo quantity of gastric juice may again be vomited. The patient in this condition is hardly able to sleep for any length of time, as the pain awakens him soon after he has fallen asleep.

1 Reichmann: Berl. klin. Wochenschr., 1882, No. 40. 2Rossbach: Deutsch. Arch. f. klin. Med., 1885, Bd. 35.

The abdomen, as a rule, is sunken. The patient looks extremely pale, and his extremities are frequently cold. Severe headaches often accompany this train of symptoms, and constipation is almost a constant concomitant. After this condition has lasted for two or three days, or sometimes even longer, the nauseous feeling begins to disappear, the pains subside, and the patient experiences for the first time a desire for food. He is now able to eat without vomiting, and in a day or two feels like himself again. It is characteristic of this affection that the symptoms disappear almost suddenly, and that the patient who seemed to be in a wretched state a few hours before may now appear nearly well.

After a period of perfect euphoria, varying from several weeks to a few months or a year or even longer, a similar attack may occur. The attacks may then either recur after the same period of time, or the intermissions of health may become gradually shorter, so that ultimately the patient has hardly recuperated from his last attack before a new one supervenes. The latter condition forms the intermediary stage between periodic and chronic gastrosuccorrhoea.

During the free intervals the gastric secretion takes place either in a perfectly normal manner or hyper-chlorhydria may exist. In either case, however, the stomach remains free from secretion in its empty state.

The following cases may serve as good illustration of this affection:

Case I

R. B. I------, aged 37, business man.

During 1800 and 1S91 patient had several attacks of the then prevailing grippe. In December, 1892, after the third attack of the grippe, he was taken ill with a stomach trouble, the nature of which patient describes as follows: "I was seized suddenly with a fit of vomiting, entirely emptying the stomach apparently, but followed by successive spells, at an interval of one to-two hours, accompanied by the most intense pain. This would last from twenty-four to thirty-six hours, and sometimes forty-eight, after which the stomach would gradually quiet down so that nourishment in the form of milk - either hot milk or kumyss - could be taken in small quantities at intervals of about two hours, until a normal condition was restored, which usually took from two to three days to accomplish.

"The character of the vomit was, first, that of undigested food, followed by a strong and very acid fluid of a whitish, and finally of a greenish color, consisting principally of bile. After each of the spells mentioned the intense pain would subside, and I would fall asleep - to be awakened again by a recurrence of the pain - the intervals of sleep and suffering varying from an hour to three as I became better, and continuing until vomiting had ceased.

"During all these spells I was exceedingly nervous - the slightest noise or vibration causing pain and sometimes causing the vomiting. General condition after becoming able to sit up was one of extreme weakness - having lost from ten to twenty pounds, as the attacks were longer or shorter.

"During 1893 I was ill four or five times, in 1894 as often, and in 1895 four times. Weight previous to grippe averaged 135 to 138 pounds; since these attacks it has varied from 125 to 133".