Causes

Food and drink have much to do with the causation of acute gastritis; therefore their regulation is of importance to prevent the malady. A sensitive stomach, one peculiarly liable to acute inflammation, is inherited, or at least peculiar to certain families. Prolonged and severe anemia, cachexia, and febrile maladies predispose to gastritis, so that substances that ordinarily would not irritate, will often provoke acute inflammation of the stomach in those afflicted by these maladies.

Perfectly wholesome food may produce gastritis if taken in excessively large quantities; this is oftenest observed in children and in those who are greatly weakened by other disease or by prolonged fasting. Or, if eaten so fast as to be imperfectly chewed, which may be observed most frequently in aged persons who have few teeth and in those who eat hastily and carelessly, the bolted masses are too large or too tough for digestion, and therefore may act in the stomach as foreign bodies. Spoiled food also may produce gastritis, as when cheese is too old or milk contains irritating ptomains; when fruit is too ripe or spoiled, and meat too 'high.' Even food that is highly spiced may provoke inflammation if one's stomach is weak.

Occasionally chemical irritants are causes of acute gastritis - strong acids or alkalies are sometimes swallowed by mistake or purposely, and cause acute inflammation of mouth, esophagus, and stomach. Gastritis produced in this way is usually intense and often fatal. It is rare that chemical preservatives added to food, such as boric acid and salicylic acid, cause gastritis, although they may do so when the stomach is unusually sensitive. However, there is no cause of this malady more common than alcoholic beverages. If they are taken in excess, and especially if they are taken on an empty stomach, they provoke it. They are properly classed as chemical irritants.

Food or beverages swallowed when too hot may burn the gastric mucous membranes and excite in them acute inflammation. Mechanical irritants, such as fish-bones, tacks, bits of glass, and similar solid articles, may cause gastritis. A blow upon the epigastrium has also been known to produce this malady, especially if the stomach is unusually sensitive for any reason. The idiosyncrasies of some persons may make a poison of food that is quite wholesome for other people. There are those who cannot eat eggs; others who cannot eat fish; a few who cannot eat strawberries - without having an attack of gastritis.

The numerous causes of acute inflammation of the stomach show the need of care as to what food is eaten and how it is eaten, in order to prevent this disease; a care that those who are predisposed to it must especially exercise.

Acute gastritis is of all grades, from the fatal burn made by a strong acid to the slight disturbance of secretion produced by excess of food in a vigorous man. In cases of the latter kinds the stomach will be distended, its churning movements will be imperfect or irregular, its juice unable to dissolve any but a small part of its contents, and digestion will, therefore, be slow and imperfect. The food will remain in the stomach long enough to spoil, and the products of its fermentation will irritate the mucous membrane still more. A few hours of discomfort are often all that is caused under these circumstances.

Acute catarrhal inflammation of the stomach is accompanied by a diminished secretion of free hydrochloric acid and pepsin, and usually by an increased formation of mucus. The movements of the stomach may be lessened or imperfect; more frequently they are spasmodic, producing colic or pain, or reversed, producing vomiting.

Treatment

Nothing leads to a cure so certainly as abstinence from food for two days. The stomach is thus given a physiologic rest. In the mildest cases a little food may be given. In many others it need not be withheld more than twenty-four hours. It is often difficult to persuade patients, and even harder to persuade their friends, that it is safe to go without food for two days. That it is safe has been demonstrated so frequently that no proof need be cited. Experience has proven the utility of abstinence from food in gastritis beyond peradventure. In the severest cases even a longer time must elapse before the stomach is used for digestion, but food must, during this period of abstinence, be given in the form of rectal injections. But even in severe cases usually from a teaspoonful to a tablespoon-ful of peptonized milk may be given by the mouth at the end of the second day. These small quantities should be administered every half-hour or hour. Although most patients are strong enough to go without food for one or two days without suffering dangerous weakness, it is not safe to starve for even a short time those who are already feeble. Such patients should be given nutritive enemata from the start.

In severe cases vomiting is an early and constant symptom.

It can be lessened by feeding bits of ice so that a wineglassful will be taken in the course of an hour and a half or two hours. Cold, effervescent drinks, such as Seltzer water, also help to lessen it. A mustard plaster or a poultice placed on the epigastrium sometimes gives relief.

Thirst is always increased and often intense. Bits of ice, or water taken in sips, will help to quench it. Care must be taken that too much be not swallowed as it will then provoke vomiting. Many times thirst can be lessened by rinsing the mouth frequently or by holding a mouthful of water for some moments. If water is made slightly acid by a little phosphoric or muriatic acid it will be grateful, and the temptation to drink large quantities will be lessened. When thirst is excessive and vomiting prevents drinking, water must be given by the rectum or by hypodermic injection.

After the requisite period of abstinence, milk should be given: at first only one or two tablespoonfuls each hour, but if it is well tolerated, one-half or two-thirds of a glass may be given every two hours. Occasionally it is vomited in large curds. This may be prevented by giving it diluted with lime-water or Seltzer, or by boiling it and thickening it slightly with flour. It is rare, however, that it is undigested, if it is given at first in spoonful doses and only gradually in larger amounts. Even persons who do not like milk or with whom it does not agree can usually be taught to tolerate it when it is given in such small and slowly increasing doses. It is best to maintain a milk diet until convalescence is established. It may be fortified, as convalescence approaches, by the addition of an egg or a little wheat flour. To most persons milk is most agreeable when taken cold. A few prefer it warm, and many can digest it best when it is warmed. Occasionally a person is found who prefers it if a little spice, such as nutmeg, or table salt and pepper, is added to it. These idiosyncrasies of taste may be gratified with safety. In mild cases bouillon may be given as well as milk, and its use may be begun early in convalescence. It may be strengthened with somatose, egg, or soft-boiled rice. Crackers or stale bread and meat-juices may be added early to the diet. Then such foods may be eaten as Mellin's, malted milk, Robinson's barley, sweet-breads, squab, eggs, chicken, scraped beef, minced ham, soft-boiled rice, tapioca, baked potato, fruit-jelly, baked or stewed apple, and prunes.

Care must be taken during convalescence not to give food in too large quantities or food that is not easily digested, for the digestive power of the stomach is so lessened that it is easily overtaxed. If the food ferments, producing acetic, lactic, or butyric acids or other irritating substances, a relapse will be provoked. Such fermentation will surely occur if foods stay too long in the stomach. Patients should be cautioned to eat moderately and to eat only the simplest foods for three or four weeks after recovery, because the stomach is left unusually sensitive by this disease for some time.

Tea is generally tolerated earlier than coffee, but neither should be permitted until the patient has recovered. When they are allowed, only a very small cup of either should be taken, and it should be weak. Alcoholic beverages must be forbidden. When they are the cause of gastritis, they should be forbidden permanently. It is true that dry champagne is sometimes administered with benefit in sips, to lessen vomiting.