G18 THOMAS K. BROWN AND JOHN H. KING 



Metabolic Disturbances in the Various Gastric 



Diseases 



Gastritis. In severe cases of acute gastritis, especially those of toxic 

 or infectious origin and associated with enteritis, there may be rapid loss 

 of weight and marked inanition, increased by the vomiting, diarrhea and 

 fever so often present. In the ordinary chronic gastritis, on the other 

 hand, due to long lasting indiscretions in food and drink, tobacco, or 

 chronic infections of the mouth and accessory sinuses, it is surprising 

 how long the condition may persist with no or very slight evidences of 

 malnutrition, and here again the determining factor is whether or not 

 the intestine is involved. In the late stages of chronic gastritis with 

 achylia, such involvement is the rule, sometimes with diarrhea, sometimes 

 with constipation and then considerable disturbances of nutrition are 

 likely to be found. It is also surprising that in many cases notwithstand- 

 ing the abnormal condition of the mucosa, how little the gastric mus- 

 culature is affected, assuming of course that pyloric obstruction is not 

 present. In the gastritis associated with pyloric obstruction due to ulcer, 

 carcinoma, etc., it is far more the obstruction than the gastritis that affects 

 metabolism. 



Gastric Ulcer and Gastric Erosions. There are, many factors in 

 gastric ulcer or gastric erosions, especially if pyloric, that affect body 

 metabolism. If, for example, the intake of food is associated with pain, 

 the patient develops a true sitophobia, and, although the appetite may be 

 normal or even increased, this fear of eating may bring about such a 

 diminution in the food intake as to lead to marked emaciation and often 

 to the suspicion that the case is malignant. Whatever be the cause of 

 ulcer, in more than 50 per cent of the cases in our experience hyper- 

 chlorhydria or hypersecretion is found, usually associated with pyloro- 

 spasm, delayed emptying time and chronic constipation, often leading to 

 mild nutritional disturbances. On the other hand, if food gives relief 

 as in duodenal ulcer the intake of food is often increased and there may 

 be even an increase of weight. In cases associated with frequent vomit- 

 ing, notably pyloric ulcers with subsequent motor deficiency, nutrition 

 may be very markedly affected, and in some cases the most extreme emacia- 

 tion develops. If profuse hemorrhage or persistent bleeding takes place, 

 we have the metabolic picture of a rapidly or slowly developing anemia 

 superposed upon the picture. Persistent pylorospasm or hourglass stomach 

 may affect the nutrition of the body by lessened intake of food due to pain, 

 or by vomiting, or by its effect on the motor function. The motor function 

 may be seriously affected if a contracting cicatrix is found or if perigastric 

 adhesions develop or if inflammation or edema is present to a marked ex- 

 tent and if true obstruction develops, we have the picture of motor insuffi- 



