Probably the commonest form of indigestion is that associated with and dependent on a hyperacidity of gastric juice (hyperchlorhydria). This condition occurs most commonly in young adults, especially men; some marked examples are met with in schoolboys. In its later stages it is associated with other pathological conditions, such as (1) slight dilatation of the stomach; (2) gastric catarrh, with excessive secretion of mucus; and (3) spasm of the pyloric end of the stomach, of an intermittent character. It is not infrequently associated with a gastric or duodenal ulcer. The symptoms produced by hyperacidity are burning pains in the region of the stomach, heartburn, flatulence, eructation of acid food, and, as a rule, constipation. The pain has characteristic features. It occurs from one and a half to two hours after food; it is relieved by food - hence the term hunger pain - and also by the administration of alkali, e.g. bicarbonate of soda or carbonate of magnesia; and, further, the pain develops after a meal of easily digested food as quickly as it does after a heavy meal. Another feature of the pain, in bad cases, is its liability to occur during the night, some hours after the last meal. In these cases the pain may be of a very severe, paroxysmal character, closely resembling the pain of biliary colic.

The cause of this condition is unknown. It is believed that it may arise from long-continued errors in diet, especially the excessive use of protein food, hurried, irregular meals, imperfect mastication, injudicious use of stimulants and tobacco - more particularly in constipated subjects.

Treatment

Complete rest in bed for one or two weeks or more is an important factor in treatment. Under its influence the gastric pains may greatly diminish, and the general condition of the patient improve. The bowels should be freely opened by a dose of calomel, followed by a morning saline of strength sufficient to clear the bowels out thoroughly. An occasional saline is also of value in the later treatment. In some cases associated with dilatation of the stomach much benefit is obtained from washing out the stomach nightly. Attention to the toilet of the mouth and thorough mastication are important factors in treatment.

The chief principle in the dietetic treatment is the use of such articles of food as combine most readily with the excess of acid. Protein foods meet this requirement. Milk, eggs, and meat should bulk largely in the dietary. It is sometimes contended, on the supposition that excessive use of protein has been responsible for inducing the disease, that it is inadvisable to continue a regime which, while relieving the symptoms, perpetuates the disease; and the supporters of this view recommend a diet less rich in protein, one containing farinaceous foods suitably combined with protein. This objection is really more theoretical than practical; and, in general, it may be said that a diet relatively rich in protein is pre-eminently the diet for this disease. Large doses of alkalis, e.g, bicarbonate of soda or carbonate of magnesia, given in 30 to 40 grain doses about two hours after food, neutralise the hyperacid state of the gastric secretion, and are a valuable adjunct in treatment.

Fats tend to lessen the acidity of the gastric contents, and are therefore to be commended; they are best given in the form of butter and cream. Milk is valuable, in virtue of its being an efficient acid neutraliscr; it is best given with the addition of lime-water, in proportion of one part lime-water and four parts milk. Foods rich in carbohydrates are to be taken sparingly, because free acid appears in the stomach soon after their administration, which interferes with the normal conversion of the starch under the influence of the saliva. The addition of a liquid extract of malt to the food aids the digestion in these cases, and sometimes has a remarkable effect in at once relieving the pain.

The most suitable vegetables are spinach and cabbage, flower of cauliflower, asparagus, stewed onions, vegetable marrow; and potatoes, peas, carrots, turnips may usually be given in moderation in the form of purees. The amount of salt taken in the diet should be restricted, since there is reason to believe that the addition of much sodium chloride favours the formation of hydrogen chloride (hydrochloric acid) in the gastric secretion.

The following dietaries are given as the most appropriate for the treatment. No. I., a rich protein diet, is the one to be most commended; No. 11., a less rich protein diet, in which the farinaceous foods are combined with proteins, has advantages in certain cases where the previous history of the patient points clearly to the long-continued excessive use of protein foods as a causal factor in the disease.

It will be observed that in both of these diets simplicity is aimed at, cutting off or restricting the amount of stimulating articles of diet, such as tea, coffee, alcohol, mustard, pepper, and vinegar; soups are not allowed because of their bulk, and, in the main, their poor nutritious value; pastry and savouries are forbidden.

Diet I. Rich Protein Diet

Breakfast

Milk, flavoured with tea.

Two eggs, or steamed fish, or slice of cold tongue, or slice of boiled bacon; one slice toast.

11 A.M. - Milk, 1/2 pint; or Hoff's malt extract (Homax); a biscuit.

Lunch -Steak or mutton chop (grilled), or roast chicken; cauliflower or stewed onions; slice of toast.

4.30 P.M. - Tea made with milk, and a little cream.

7 P.M. - Alternative diets.

Fish and chicken; meat and cheese savoury; meat and entree.

9.30 p.m. - Glass of milk.

Diet II. Milk And Carbohydrate Diet

8.30 A.M. - Coffee or cocoa, with plenty of milk. Bread, toast, roll, or rusk. Butter, honey, jam, or marmalade.

11 a.m. - Milk, and one egg beaten up.

1.30 p.m. - Meat, fish, chicken, game, sweetbread; no vegetable. Pudding - milk pudding, or stewed fruit or jelly. Cheese, biscuit, and butter.

4 P.M. - Milk tea, and one rusk or biscuit.

7.30 p.m. - Small bowl of clear consomme (p. 271).

Fish or meat, one vegetable, potato, spinach.

Pudding

jelly, custard, blancmange.

Cheese, biscuits, and butter; light cheese savoury.

9.30 p.m. - Milk diluted, in all half a pint.

In persistent cases of long standing, when the general nutrition of the patient is below par on account of his or her attempts to correct the condition by adopting a semi-starvation diet, it is advisable to put the patient to bed for ten to fourteen days, and for the first week give an exclusive milk diet - 2 to 4 pints of milk daily. A daily dose of Carlsbad salts given on an empty stomach the first thing in the morning, should also be given. In the second week the diet may be extented by the gradual addition of eggs and malted Farinaceous foods, milk still forming the staple of the dietary.