Causes

Chronic gastritis frequently grows out of acute inflammation of the stomach. The dietetic faults to which the acute disease can often be ascribed are not uncommonly the causes of chronic inflammation also; but it sometimes develops slowly and insidiously.

Excess in eating is a common cause of chronic gastritis, especially excess in eating rich, highly spiced foods. The constant use of strong alcoholics and the excessive use of the milder ones are also among the commonest causes of it. They lessen the muscular activity of the stomach and the vigor of the lymphatic circulation in its walls and in the liver, gradually producing slow digestion and slow absorption. Abnormal fermentation of the contents of the stomach occurs almost always. All these factors combine to produce inflammation of the stomach. To prevent gastritis of this origin, two things are necessary: first, exercise so active as to insure deep breathing and a vigorous use of the abdominal and thoracic muscles, which will result in better peristalsis and a more vigorous circulation of lymph; secondly, regulation of the patient's diet.

Not infrequently mental depression, business worries, family cares or sorrow, are causes of chronic gastritis, but they rarely are the only cause. As a rule, injudicious eating or a sedentary life is partly to blame. Still, the part that mental depression plays in provoking gastritis must be remembered, for often the removal of a patient from uncongenial or depressing surroundings, or from a business that entails constant anxiety and care, does more to effect a cure than any other remedial measure.

Most diseases that produce long-continued debility predispose to chronic gastritis. Among these are chlorosis and other severe anemias, tuberculosis, malaria, and nephritis. The enumeration of these causes of chronic gastritis suggests their removal or avoidance, and therefore the prevention of the disease.

The stomach's wall may be thickened, its mucous membrane may be thrown into deep folds or may be 'mammillated,' or it may be thin, the gastric glands atrophied and destroyed, so that they no longer perform their function. Such "a pathologic classification is not so useful as a clinical one made by many authors who place cases of chronic gastritis in four groups, according to the functional power of the stomach, which is estimated by its power to do chemical work. The first group embraces those in which free hydrochloric acid exists in normal or increased amount. These are mostly cases in an early and transitory stage of chronic inflammation. For instance, the habitual and free use of alcoholics commonly produces at first an excessive secretion of gastric juice. The second group is characterized by a formation of free hydrochloric acid in less than normal quantities. The third contains cases in which an excessive formation of mucus takes place. An abnormally copious secretion of mucus may occur in any of the other forms of the disease, but rarely in the first, and never to the extent that it may in the second. The fourth group is one of atrophic gastritis, when all gastric secretion, whether of free acids, pepsin, or mucus, ceases.

While alcohol often provokes an excessive glandular activity at first, it soon leads to the production of an excess of mucus and to lessened secretions of gastric juice. Later, in the same individual, atrophic gastritis may follow. Thus one individual may at different times be placed in each of the foregoing groups of cases of chronic gastritis. It is not always true that a chronically inflamed stomach passes through these stages. The inflammation may, from the start, produce such changes in the functional power of the stomach as to place a given case in any category from the beginning.

Treatment

In many cases certain subjective symptoms enable physicians to determine whether there is a diminished secretion of gastric juice and whether an excessive formation of free hydrochloric acid is taking place. In other cases these distinctions can be made only by repeated chemical examinations of the stomach-contents. A diet must be carefully prescribed for each class of cases. The chemical character of the gastric juice and its quantity are the most important guides in prescribing a bill of fare. It is desirable, so far as possible, to select foods that are palatable to the patient, and for this reason to inquire minutely as to what he is accustomed to eat and what foods he especially likes. The method of cooking must also be considered. In general it may be said that fried foods, pastries, and foods that are excessively sweet must be forbidden to all who suffer from gastric disorders.

In cases of mild gastritis of either an acute or chronic type a radical change of foods will effect a cure even when little attention is paid to the exact needs of the patient. The reason for this is that when the patient ceases to eat his accustomed food, he will eat a smaller quantity. It must always be remembered that when the stomach is impaired it is unable to digest as much as when strong. Many patients suffering from mild gastritis have an exaggerated appetite, and many others eat too much from habit. Those who are very ill frequently are given too much food by solicitous friends. The quantity that each patient is to eat must be prescribed with especial care. It can often be determined only by trial.