The allergic epigastric syndrome

Abstract

The allergic epigastric syndrome is characterized especially by pressure, tightness, and burning in the epigastrium, associated with belching, heartburn, sour stomach, and mid-and lower abdominal distress in varying degrees and frequency. Substernal burning, aching, and some soreness, at times precordial distress, erythema, and burning in the mouth and other results of oral allergy, headaches at times with nausea and vomiting, fatigue, mental confusion, and other symptoms of allergic toxemia, diarrhea, and especially constipation may occur in these patients. Physical examination and laboratory studies were negative in all of the 50 patients in this series except for achylia in two patients. X-rays of the upper gastrointestinal tract were negative in 45 patients but revealed apparent hypertrophied rugae in one case and pyloric spasm with an irregularly segmented small bowel, best explained by food allergy, in another case. Although gastroscopy was refused or omitted in nearly all patients, largely because of the rapid improvement and later control by the proper diet, edema and erythema in one patient and probable hypertrophic gastritis in another patient were seen. Removal of gallstones in one case did not relieve the epigastric syndrome until the proper antiallergic diet was given. Symptoms relieved by the diets had been ascribed in several patients to nervousness, the attempted relief of which was ineffectual. Food allergy was the evident cause of this syndrome and of the associated symptoms, except most of the constipation, in the 50 reported cases. This food allergy was indicated in some patients by a history of disagreements to foods and less often of dislikes for specific foods and rarely by clinically proved positive skin tests and in all cases by relief of symptoms by diet trial with the senior writer's indicated elimination diets.