The treatment of chronic gastritis necessitates constant medical supervision. A strict diet must be conscientiously adhered to. This should consist of easily digestible, semi-liquid foods of high nutritive value. The bowels must be carefully regulated. Various forms of water-treatment may be resorted to, but these, as well as certain internal remedies, must be prescribed by the physician for each individual case.
Dilatation of the StomIch.—By this is meant the relaxation and expan sion of the walls of the stomach beyond their normal limits. In healthy individuals the stomach usually sinks to the level of the navel. The lower border of a dilated stomach sinks two or three finger-widths below this level ; and in severe grades of dilatation it may even extend down to the pelvic bones. Such a stomach may hold two or three times as much as a normal one, its fluid capacity being from three to five quarts. The walls of a dilated stomach are always very distended, relaxed, and thin ; and the organ hangs like a heavy sack in the patient's abdomen.
The principal symptom of this morbid condition is loss of elasticity of the walls of the stomach. The muscles are no longer capable of discharging the contents of the stomach into the intestine through the pylorus. This gives rise to the accumulation of food, which soon undergoes fermentation and putrefaction, forming gases and acids, which are constantly emitted by the patient. It frequently happens that the superfluous contents of the stomach are discharged by vomiting, which may be very profuse and annoy ing. This is sometimes accompanied by severe pain in the stomach, a sensa tion of fullness, and pressure in the entire abdomen, belchings of sour gases, passing of wind, and persistent constipation, so that the affection is a very disagreeable one.
The development of the dilatation usually takes place slowly, and the affection may exist for many years before reaching its maximum. The severity of the disturbances depend upon the degree of dilatation. Mild degrees are often borne for years without essential impairment of health and nutrition, whereas severe cases cause marked emaciation. Such malig nant cases may even lead to death from starvation, because too small an amount of food reaches the intestine, the real seat of nutrition. Dilatation
of the stomach is rarely due to a simple distension and relaxation of its walls. The higher grades almost invariably develop from the formation of scars which narrow the pylorus, such as frequently occur in connection with ulcers of the stomach. The pylorus (see p. rA.8) becomes so narrow that fluids can pass it only slowly and in small quantities ; solid food not at all.
The treatment of dilatation of the stomach is very difficult, and a cure very uncertain, especially in the severer grades. If narrowing of the pylorus be the cause of the affection, surgical interference is necessary. Operation consists in extirpating the narrowed pylorus or, better still, in establishing an artificial passage between the stomach and the intestine by the operation known as gastro-enterostomy. The physician will advise the performance of such an operation only in far-advanced cases which have led to great emaciation and loss of strength. In milder cases internal treatment may bring about considerable improvement, although not a complete cure. Such treatment consists, above all, in maintaining a continued and strict diet. The patient should not partake of large meals, but should eat frequently, and only a small amount at each meal. Only very nourishing foods, of liquid or pap-like consistency, should be eaten ; and dishes that are difficult to digest should he strictly avoided. Mineral waters, coffee, tea, beer, wine, and thin watery soups should not be taken ; while milk, cream, chocolate, and cocoa are to be recommended. Butter and minced veal are likewise advisable. The physician should, in every instance, furnish the patient with a detailed bill of fare, which must be changed from time to time.
In most cases it is necessary to remove the undigested food remaining in the stomach by washing out the organ in the morning or late at night. This daily washing of the stomach is a valuable remedy, frequently protect ing the patient from vomiting. Attention must always be paid to regular, abundant, and easy movements of the bowels. Massage of the stomach, electricity, and the application of water usually strengthen the muscular power of the relaxed stomach.