Subacid gastritis is that form in which the secretion of TIC1 is diminished in slight or extreme degree and there is co incident, but far less extensive, diminu tion in secretion of the ferments. Sub acid gastritis may terminate in so-called (d) atrophic gastritis, in which, with more or less complete atrophy of the glandular elements, even traces of are no longer apparent, and the ferments, though rarely disappearing entirely, arc recognizable with difficulty only in their inactive or proenzyme stage. In this condition there finally occurs complete disappearance of the secreting structure, with absence, even, of traces of the proenzymes.
Mucous gastritis is characterized by the almost habitual appearance in the wash water or in the vomit of a considerable quantity of mucus.
Symptoms. — Chronic gastritis is of very insidious onset, and is attended by a train of symptoms more or less striking and serious, depending upon the degree of its existence and the variety. These symptoms are those of disturbed diges tion, such as loss of, or variable, appe tite, and perhaps actual distaste for food other than that highly seasoned; bad taste; an habitual coated tongue in the morning and of its root as well through the day; at times nausea and vomiting, the last occurring especially in the chronic gastritis of alcoholics, when it is usual in the morning on arising and then consists of glairy mucus; gaseous eructations; pyrosis; "heart-burn," com mon in acid gastritis; fullness and heavi ness in the epigastrium after meals—less usual in acid gastritis.
The vomited matter rejected by day, after food has been taken, as with the stomach-contents extracted through the tube, will show the presence or absence of HCl and the ferments according to the length of stay of food in the stomach and the variety and stage of the gastritis present, whether acid, subacid, or atro phic. Mucus is apt to be present in con siderable quantity, as are yeast-cells and bacteria which have made a habitat of the mucous membrane of the diseased stomach; leucocytes in abundance and erythrocytes in small amount may be rec ognized, especially in the wash-water of the fasting stomach. Lactic acid is un usual, save in traces derived from the food ingested, except with coincident dilatation and a high degree of stagna tion. With similar dilatation and stagna
tion, but with presence of free IIC1, sar cinx are encountered. These arc espe cially noted in the lifted contents or in the vomit in the morning before food has yet been taken.
Gastric pain sometimes occurs in all forms, but is most usual in the gastritis of excessive drinkers. There is then present diffuse soreness, amounting, per haps, to actual pain, occurring commonly soon after meals, but which may be pres ent on the empty stomach. In amount and character the pain is occasionally of such severity as to originate a suspicion of cancer or of ulcer. The pain may be of the nature of gastralgia, paroxysmal and variable in occurrence, and may then be associated with diffuse or localized tenderness on pressure.
The bowels are apt to be more or less habitually constipated and the fmces malodorous.
Through the long-continued imperfect digestion the bodily nutrition suffers and loss in weight and a moderate anaemia or chloramemia occurs. In atrophy of the gastric tubules with marked impairment of the motor power, or with preserved motility and presumed failure of pan creatic secretory activity, due to disease of that organ. anaemia is common and may assume the characteristics of the pernicious (so-called idiopathic) grade.
The urine in mild chronic gastritis shows no special characteristics. In that in which the nutrition suffers the urine is apt to be diminished in amount, and thus of a relative high specific gravity, but actually with considerable diminu tion in amount of total urinary solids, notably of urea. The phosphates are increased and the acidity diminished.
The motor function of the stomach, especially in the early stages of chronic gastritis, is in some cases increased. Commonly in the later stages it is im paired more or less markedly, although the gastric capacity may not be increased, the diminished gastric peristole being due to coincident atrophy of the muscularis as a result of connective-tissue increase and to the lowered nutrition present.
Headache is common; attacks of mild or pronounced vertigo sometimes occur, and marked mental depression is usual. Actual melancholia may develop.
Although chronic gastritis may occur at any age, it is most usual toward mid dle life and is more common in men.