Causation

Dilatation of the stomach may result from stricture of its pyloric end, or from chronic gastric catarrh, in which case it is accompanied by the secretion of much tenacious mucus. The stricture may be due to a carcinomatous growth, to hypertrophied mucous membrane caused by chronic gastritis, or to contracture following gastric ulcer.

Gastric dilatation is also produced by loss of tone or paresis of the muscular coat, by destruction of the muscular coat due to ulceration, and by lack of proper nervous or nutritive supply, such as results from debilitating illness, like typhoid fever, tuberculosis, or general nervous prostration. Less often it is caused by abuses of diet, especially those which give rise to much gas by excessive use of effervescing beverages, etc. The varieties due to gastritis, debility, and dietetic errors are most amenable to treatment.

Pathological Physiology

The food is improperly digested, owing to want of gastric juice and of peristalsis or to admixture with quantities of mucus. It therefore lingers in the stomach beyond the usual time, ferments, interferes with thorough digestion of the next meal, and renders the chyme unfit for the intestine. Food will often lie undigested in a dilated stomach all night, and be vomited with accumulated mucus in the morning. The undigested food accumulates, and by its weight drags down the stomach and favours further dilatation by stagnation and development of gases. The motor function of the stomach is almost completely suspended, and the organ must therefore be taxed as little as possible.

Dietetic Treatment

For these reasons it is necessary to limit the quantity of solid, and especially of fluid nourishment. Nothing but the simplest articles of diet should be allowed. All food should be given in a concentrated and readily assimilable form, so that it will either be absorbed directly from the stomach wall or pass promptly into the duodenum.

In bad cases food should be predigested as much as possible, although many of the predigested foods are open to the objection that they are much diluted in the process, and are therefore less serviceable. The more concentrated varieties should be chosen. Ewald recommends the employment of peptonised condensed milk, which is very nutritious and of an agreeable flavour. It should be condensed without addition of the usual excess of cane sugar, which will surely ferment in the stomach.

The patients are often thirsty, and, in fact, the original dilatation may have been caused by excessive imbibition, but the amount of fluid drunk with meals must be restricted to four or six ounces, or in bad cases no fluid at all should be allowed at mealtimes. If the thirst is considerable, a tumblerful of hot water may be taken a half hour before meals, to be absorbed or pass into the intestines before the food enters the stomach. Water is more quickly absorbed hot than cold. In bad cases thirst may be relieved by water enemata, but they are rarely necessary.

The proper diet for gastric dilatation is the same as that recommended for chronic gastritis, except that it is even more concentrated and smaller in bulk, and farinaceous food is almost wholly forbidden.

At first only animal food should be given, such as scraped beef or a piece of broiled chicken, with perhaps a very little dry toast or toasted cracker. If vomiting is a persistent symptom, Petrequin advises the patient to drink milk very slowly, taking crushed ice with each mouthful. Later, after from two or three to six weeks, if improvement has resulted, more latitude is permissible, and the food advised is lean meat free from coarse fibres; fresh vegetables, young peas, asparagus, tomatoes, tender and well-cooked purees, dry bread, haricots, lentils, lettuce or cress with vinegar, simple starches, such as sago, macaroni, rice, tapioca, and vermicelli, boiled or broiled oysters or fish, soft-cooked eggs, orange juice, stewed or baked apples without sugar, stewed pears. Some patients may drink a tumblerful of boiled milk between meals, but, as a rule, it is best to take nothing. Some dietists recommend a perfectly dry diet, omitting all fluids, and order three meals a day at long intervals. In mild cases, coffee and tea without sugar are allowed.

To be avoided are most forms of starchy food, and sugar, potatoes, old peas, beans, corn. Fruit consists largely of water in proportion to its nutritive value, and its vegetable acids are apt to disagree. It must therefore be eaten sparingly. Fats, butter, and oils are not digested in the stomach. Thirst-exciting foods, as salt fish, must not be taken, nor beer, effervescing mineral waters, red wine, thin soups, milk, water, tea, coffee, diluted or light alcoholic beverages.

In all cases too long continuance of a very rigid diet is liable to cause the patient or the stomach itself to rebel. The patient should be weighed once a week. The stools must be examined and the general nutrition carefully considered. If weight is rapidly lost, the food, whatever it may be, is not being assimilated, and it should be changed. It may become necessary to disregard the rules for fluid and put the patient for a time upon a diet of prepared milk.

Aids To Dietetic Treatment

Other means of treatment which are really adjuncts to dietetic measures should be recommended. Such are lavage, massage, and electricity, which will be considered below. Mucus, especially that which is accumulated overnight, may be washed out of the stomach by sipping a cup of very hot water or taking alkaline mineral water, or a pint of water with ten grains of bicarbonate of soda, on rising.

It is often desirable for the patient to lie down for an hour and a half after eating, and he should especially avoid mental and bodily fatigue, which tend to divert both nerve energy and the blood from the functions of digestion.

Hydrochloric acid and pepsin mixtures with the nitrogenous diet are serviceable.