The course of chronic gastritis is vari able. If encountered early and properly treated recovery is usual. Later, with marked anatomical changes in the stom ach, as evinced by persistent diminution in secretory or motor activity, the prog nosis is grave, although, even in extreme atony of the tubules with restored motor power and preserved pancreatic activity, the patient may, to all appearances, re gain and maintain health for a long period. The writer has now had several cases of this sort under observation for a few years in which, with total secretory loss, originated by a chronic gastritis, the general health is well maintained.
Diagnosis. — A diagnosis of chronic gastritis not secondary to another gastric disease—such as carcinoma, dilatation, or to an obstructive disease of the liver, or the heart, of the lungs, or to disease of other organs, such as the kidneys—must only be reached by the most searching exclusive process. Otherwise it is but symptomatic, and the treatment is prac tically valueless. A separation of the different varieties of gastritis, the acid, subacid, atrophic, and the mucous,—the first two of which may have associated with it the last,—the recognition of mo tor increase or impairment, can be readily made as a result of a sufficient number of examinations by means of the stomach tube, and the application of the most ap proved clinical and laboratory methods, none of which, of actual value, are diffi cult to employ or to comprehend after a little experience with them. Unfortu nately space is not permitted here for their detail.
In the differential diagnosis of chronic gastritis it is especially important to ex clude the simple gastric neuroses and carcinoma and ulcer of the stomach. Attention to the symptomatology of these affections and patient study of the case under view will commonly enable a sep aration to be made. In excluding a neu rosis, especially that form characterized by hyperchlorliydria or by anacidity, it is especially important to consider the preceding history and the accompanying objective and subjective symptoms; to make examinations of the stomach-con tents in order to ascertain the condition of the secretory and motor functions on a number of occasions, and to repeat these at definite intervals; to recall that in these gastric neuroses there is not infre quently a total reversal of what has seemed the usual condition, marked atony being succeeded by hypermotility, and subacidity or anacidity, or hyper chlorhydria by its antithesis. The
habitual presence of considerable mucus in the wash-water; of some amount of the organic acids, such as butyric or acetic; of, microscopically, leucocytes and of bacteria, and of exfoliated epi thelium, of course, favors gastritis.
Any comprehensive survey of the dif ferential diagnosis is not permitted here. It is especially important to separate car cinoma and ulcer of the stomach from chronic gastritis. In carcinoma, more especially of the pylorus, with the accom panying stagnation and decomposition of food in the stomach, there are absence of free HC1 and the presence of consid erable amounts of lactic acid; vomiting is usual, the vomited matter showing indications of bright-red or, more likely, altered blood; there is more or less char acteristic pain; and emaciation is more rapid than in chronic gastritis; often the presence of a tumor may be detected.
In ulcer there is localized and usually intense gastric pain and tenderness, the pain often extending through to the back. Gastric haemorrhage, causing, although not always, hwmaternesis and the pres ence of blood in the stools, is more or less usual, although not invariable as concerns detection.
Etiology. — Chronic gastritis may be either primary or secondary to a pre existing disease of the stomach, such as carcinoma, dilatation, simple atony, ulcer, or to disease of the teeth, of the mouth, of the throat, or as a result of chronic venous engorgement of the stomach de pendent upon obstructive disease of the liver, the heart, or the lungs; or to cer- ' tain constitutional states, such as the dis eases of the blood, tuberculosis, diabetes, and to chronic nephritis.
The usual causes of primary gastritis are long-continued dietetic indiscretions; eating food improper in quality or quan tity; meals at irregular or at too short intervals; habitual overeating, especially when fatigued; drinking large quantities of fluids with the meals, especially if iced or at a very high temperature; imperfect mastication and insalivation of food through carelessness or through ab sence of teeth (this last is a common and often overlooked cause). The abuse of alcohol is a very common cause of gas tritis.