As a primary disease, chronic gastric catarrh is due to the same causes as the acute form. It is a common consequence of influenza and the fevers. It may also follow an attack or recurrent attacks of acute gastritis; and the innumerable causes of indigestion by their persistence very frequently lead to chronic gastric catarrh or catarrh of the stomach. Acid foods and such as undergo acid fermentation in the stomach are among the commonest causes of this complaint. Sugar gives rise to acidity. Starch (in bread, rice, oatmeal, sago, tapioca, etc.) does not give rise to acidity while the gastric juice and motor activity of the stomach remain normal, because it escapes through the pylorus without any change. But if the motor power of the stomach is defective there is a delay in the passage of starchy foods into the bowels, and they undergo fermentation which results in the formation of acids having an irritating character.

Butyric acid arises during the fermentation of starch and sugar in the stomach. It is one of the most irritating acids. It should be pointed out that this acid occurs normally in butter. Good butter contains but little, but cheap butter and that which has become rancid contains much more. Cheap butter is very often used for cooking purposes; this is wrong in principle, and it is a very common cause of catarrh of the stomach. The flavour of rancid butter may be hidden by mixing it with flour and the other ingredients of cakes and pastry, but the butyric acid is not destroyed thereby. Acetic acid and lactic acid are also formed in the stomach, but they are more often taken in the food. Acetic acid occurs naturally in vinegar and pickles, lactic acid in sour milk and foods made with it. Tartaric acid, acetic acid, malic acid, and many others occur in fruits and wine. Spirits act as local irritants to the stomach, and some of the alcohol may be transformed into acetic acid. It may, therefore, be said that primary chronic catarrh of the stomach arises from improper feeding, habits of intemperance, and accidental causes. But it is probably as a secondary affection that chronic catarrh of the stomach will most often be met. It complicates very many diseases, but especially results from congestion of the portal veins (the venous system of the abdomen), diseases of the liver, affections of the heart, lungs, and pleura. Take the flabby and enfeebled heart of an elderly person as an example. In such a case the circulation is very feeble, the abdominal veins become engorged with blood because the heart is unable to keep it in circulation, and thereby leads to passive congestion of the liver, and of the mucous membranes of the alimentary canal, with catarrh thereof and its attendant evils.

The cause or causes of acute catarrh of the stomach are very often local, and the intensity of the irritation secures the removal of the irritating substance by vomiting. In chronic catarrh the irritation is far less intense, but the long-continued irritation or passive congestion produces equally serious results. The changes caused thereby are no less because they are produced gradually. The mucous membrane of the stomach becomes thickened, the submucous and muscular coats hypertrophied. The mucous membrane is covered with a thick and tenacious mucus; when this is removed it appears paler than usual, possibly with varicose veins here and there; it may be thrown into irregular folds or be marked here and there by slate-coloured patches resulting from slight extravasation of blood.

The patient complains of pain and tenderness at the pit of the stomach, or it may be a sensation of weight, of gnawing, or cramp at the stomach. These symptoms are perceived most frequently in the morning, that is, when the stomach is empty. There may be sickness in the morning; the vomit consists of saliva swallowed during the night, and perhaps a tasteless transparent ropy mucus, somewhat like the white of an egg, containing the bacteria and fungi which cause fermentation and acidity. But vomiting is not a constant symptom of the disease; some people never vomit, others only vomit occasionally and after some indiscretion in the diet. The tongue may be coated with a white or creamy fur through which the enlarged papillae are visible; in other cases it is red and the enlarged papillae are as visible as in the "strawberry tongue" of scarlet fever. The lips are often dry and cracked, the gums spongy and discharging. In addition there are the usual symptoms of indigestion. The general condition is that of "being out of sorts," the patient is listless, languid, unable to make any exertion, or is easily exhausted. The nutrition of the patient fails because the gastric juice is deficient in hydrochloric acid, which is one of its normal and essential constituents, and in very serious cases the pepsin is also deficient in quantity.

The disease runs a very extended course. The symptoms may be very much improved by treatment, but they recur on very slight provocation at intervals of months or years. Most cases of primary gastric catarrh are curable by careful and persistent treatment and attention to the food. But secondary gastric catarrh is dependent on the causative disease, and the variations in the catarrh usually go hand in hand with variations in the disease which has occasioned it. Thus the gastric catarrh arising from passive congestion may be considerably relieved by an improvement in the condition of the heart, lungs, or liver. Nevertheless, the chronic heart, lung, or liver disease persists, consequently the stomach gets worse year by year, and the body suffers as much from the imperfect digestion and absorption of food as it does from the enfeebled heart or difficult breathing.

In these cases the food is of paramount importance. But patients vary so much in their condition that no stereotyped diet will suit them all. Everything depends on the ability of the stomach to digest its contents and propel them into the bowels. All kinds of food which are capable of being digested without unduly burdening the organ and of being propelled into the bowels in a reasonable time are proper foods for the patient. It should not be forgotten that in this condition the digestive powers are feeble, and most foods require a longer time for their digestion than in a normal stomach. There must be rules for such cases, beginning with the mouth. The teeth must be carefully attended to; the deficiencies should be made good. Artificial teeth which do not remain in the place intended for them should be thrown aside, and proper fitting ones obtained. The mouth should be kept clean and as free as possible from infection. Sore gums should be healed and hardened by the regular use of a proper mouth-wash. The patient should never break his fast without previously washing his mouth and cleansing his teeth. The food must be slowly and carefully masticated. It should be of such a kind and quality that it will suit the morbid condition of the stomach. The harmonious action of the alimentary canal must be promoted. The patient should rest a short time before a meal and a longer time after it. The function of digestion should be promoted by reasonable exercise of the body, suited to the strength and condition of the patient.