The symptomatology of gastritis

Abstract

Superficial Catarrhal Gastritis occurs in young people, has a short history characterized by epigastric distress immediately on eating, not relieved by further food or alkali ingestion. This type of gastritis, if subject to frequent exacerbations, probably results in permanent atrophic changes and eventually occasions the symptoms of chronic atrophic gastritis. In well establishedatrophic gastritis the history is of persistent, constant upper abdominal distress of pressure type, not relieved by food or alkali, with anexoria and nausea, and occasional vomiting. The duration is many years. The patients are in the 4th, 5th and 6th decade, and have often lost weight and become anemic, hence to be differentiated from malignancy or pernicious anemia; they may be subject to acute exacerbations, often with sore mouth and tongue. Thehypertrophic gastric patients have epigastric pain, either immediately post cibum or at an interval thereafter, sometimes with food or alkali relief, but more often being not relieved or aggravated thereby and with a pronounced tendency to nausea and vomiting, the latter giving relief. The history is of long duration with periods of remission. The type of pain is burning or gnawing, or a dull ache, but does not radiate nor occur at night and is diffuse in upper abdomen. The X-ray findings in the superficial and atrophic forms of gastritis are negative, while in the hypertrophic forms they are equivocal, indeterminant, or show ulcer niche types of defects, often multiple. Occasionally the diagnosis of gastritis has been made, usually in the hypertrophic type by changes in mucosal pattern. There is no diagnostic aid from the evaluation of degrees of acidity of the gastric secretions in the superficial forms; the atrophic forms are distinctly achlorhydric, while the hypertrophic type may be achylic, anacid, hypo or hyper-acid, with a preponderant number of the last. Evidences of gastric hemorrhage, either hematemesis, or melena has been found with all forms of gastritis, possibly more frequently with the hypertrophic types. We agree with Benedict therefore, that hemorrhagic evidences are strongly indicative of gastritis if another responsible lesion has not been demonstrated.