DYSPEPSIA AND GASTRIC ULCER by P. JOUSSET, M.D.
It is an affection characterised by the slowness and the difficulty of digestion. The principal symptoms of this affection are a more or less painful weight in the region of the stomach, eructations regurgitations, and sometimes vomiting, constipation, or diarrhoea. Also there are other symptoms not referred to the stomach and which will find their place in the following description.
The history of intestinal dyspepsia is based upon the manifestations of disturbances several hours after meals and the coincidence of intestinal colic. The affection is never found alone, and it is but a sequelae of gastric dyspepsia, the only one which we admit.
Dyspepsia is usually a symptomatic affection. It is noticed in the following diseases: tetter, gout, haemorrhoids, hypochondriasis, hysteria, chlorosis, chronic gastritis simple ulcer of stomach and cancer of this viscus. Dyspepsia is also present, either as a precursory phenomenon, a transient symptom, or as part of the cachectic state, in several chronic diseases: phthisis, scrofula, syphilis albuminuria, diabetes etc. Affection of those organs which are in the vicinity of the stomach also produces dyspepsia: affection of the liver and of the gall bladder, intestinal affection etc. It is also met with in most cases of poisoning.
Besides dyspepsia manifests itself in those who do not present any symptom of another disease, and thus constitutes idiopathic dyspepsia.
We shall now describe the most frequent varieties of this affection, in order to reach at least a precise indication of the most appropriate remedies. Dyspepsia exhibits five principal varieties:
Bradyspepsia (slow from), pituitary dyspepsia, flatulent dyspepsia, acid and masked dyspepsia. Under this last name we shall describe that variety of dyspepsia in which the gastric symptoms are masked, so to speak. by the symptoms referred to the heart, lung and brain.
This variety of dyspepsia is the most common of all.It is characterized by the slowness and the difficulty of digestion. One or several hours after meals the patient feels a painful weight at the pit of the stomach. This pain, which in violent cases lasts to the next meal, is accompanied by a sensation of swelling.
Patients are obliged to loosen the clothing entirely. They have regurgitations. first with the taste of the food, soon after acidity, still later they vomit, which relieves them much. From time to time, when patients insist upon overeating, vomiting of food occurs, and true indigestion sets in Appetite is compatible with this variety of dyspepsia; the mouth, however, is usually foul, the tongue white, and covered with a frothy saliva.
In some rare cases the liquids especially are not digested.
This peculiar variety is recognized by the aggravation on taking liquids, by the splashing sound of the liquids produced in the stomach, by succussion, and by the scant urine. This variety is chiefly noticed in those suffering from gout and haemorrhoids.
2. Pituitary Dyspepsia: This variety of dyspepsia is characterized by the slowness of digestion, and principally by the vomiting of a transparent and more or less thick mucus. Patients affected with this variety of dyspepsia exhibit most of the symptoms of the preceding variety; furthermore, they vomit every morning with extremely violent efforts, sometimes with cough and suffocation. Once they vomit, with great difficulty, a few mouthfuls of a stringy and slimy, sometimes bloody, liquid, they feel relieved. This attack, which almost always occurs in the morning on an empty stomach, may be repeated several times during the day.
This variety of dyspepsia is symptomatic or chronic alcoholism. It chiefly develops itself by the use of strong alcoholic liquors, taken on empty stomach. Beer drinkers are also subject to this trouble. This dyspepsia is the usual symptom of chronic gastritis.
3. Flatulent Dyspepsia:
The variety is characterized by considerable formation of gas in the stomach and intestines. As soon as the digestion commences the mucous membrane of the stomach and intestines secrete, with an extreme rapidity, a great quantity of gas. Patients almost choke, and are obliged to loosen their clothing, the abdomen is greatly distended. Tympanites, borborygmi, and eructations annoy them at the height of the disease, and they commence then to belch an enormous quantity of gas. These eructations, usually tasteless, odorless, and extremely noisy, last for a long time, and end the attack of dyspepsia.
This variety is peculiarly met with in hysteria and hypochondriasis.
We connect this form of dyspepsia with deficiency of hydrochloric acid, and a certain percentage of dilatation of stomach. As to the deficiency of acid, it is marked by considerable decrease of hydrochloric acid of the stomach, when it is found to be associated with a certain degree of gastric dilatation. There is stasis of undigested alimentary substances, which ferment, and a great quantity of organic acids is formed, so that the acidity of the liquids contained in the stomach in cases of deficiency of hydrochloric acid is more common than in cases of hyperacidity; and, as these organic acids lack the aseptic properties of hydrochloric acid, the alimentary substances become decomposed, and the formation of ptomaines starts auto-intoxication. In such cases eructations may have a putrid taste and odor.
4. Acid Dyspepsia: This variety is characterized by sour eructations, acid evacuations, and vomiting. is due to an excess in the secretion of gastric juice. Patients, soon after eating, having a sour stomach, sometimes pyrosis. The saliva is acid, and sets the teeth on edge; and after gastric digestion there sometimes occurs vomiting, largely composed of gastric juice.
Hyperacidity should be connected with this form of dyspepsia; acid vomiting, acid eructations, pyrosis, and the pains, often violent, which occur four or five hours after meals, are due to this excess of hydrochloric acid. This variety is frequently connected with chronic gastritis, or it is a prodromal symptom of cancer of the stomach; it accompanies organic affections of the liver, or it may manifest itself as a symptom of gout.
5. Masked Dyspepsia:
In this variety the gastric symptoms are slightly developed while the symptoms so-called sympathetic are the more marked.
There is palpitation and irregular pulsation of the heart, lipothymia, syncope, symptoms of angina pectoris. There is arthritic dyspnoea, dyspnoea by choking sensation, dry and teasing cough. Habitual headaches, weight on the vertex, vertigo, megrim, hypochondriasis. This variety of dyspepsia is especially met with in hysteria hypochondriasis, and in haemorrhoidal affections.
To this form we connect a great number of cases of dilatation of stomach, and we are going to mention the signs that will enable us to determine this dilatation.
These signs are chiefly two: increase of the resonance and the splashing sound.
Percussion should be made on the bare skin. First the lung is located, then the resonance over the stomach.
The splashing sound is the sign par excellence. It may be obtained either by succussion or by an abrupt pressure with the closing fingers brought together on a same line, and exercised upon the regions which extend from the umbilicus to the false ribs. Should the patient’s stomach be empty, it is best to make him drink half a glass of water in order to hear this sound.
Dyspepsia with marked Gastric Symptoms. The principal remedies are Nux Vomica, Graphites, Bryonia, Pulsatilla, China Carbo veg., Lycopodium, Lachesis, Baryta carb., and Antimonium crudum.
Nux Vomica and Graphites.-Given in alternation. Nux Vomica before meals, and Graphites after, is a good treatment for dyspepsia.
Nux Vomica is the principal remedy for the stomach; it is valuable to those who suffer from haemorrhoids, and, as Hahnemann states, to strong, sanguine, and irritable constitutions. Sedentary habits, excess in alcoholic beverage, mental over-work, habitual constipation are also indications for the use of this drug.
The gastric symptoms which suggest this drug are disgust for food, with nausea, or a ravenous but easily satisfied hunger; sensation of overloading of the stomach after meals, with flat taste; eructations; bitter and sour regurgitations, pyrosis, and sometimes acid vomiting; malaise; despondency; heat and redness of the cheeks, sometimes accompanied by coldness of the body.
Graphites has similar symptoms: bitter and sour regurgitations of food, rumination, ptyalism, pituita. Vomiting of food is more marked than in Nux Vom., as well as the indigestion of liquids. This remedy answers well in cases of gastric dilatation.
Doses: Nux Vom., an hour before and Graphites an hour after the principal meals, in the 12th dilution, is my favourite dose.
Bryonia.-The character of the pain and the aggravation from motion indicate Bryonia. The pain caused by this drug is that of pressure on the pit of the stomach. This is accompanied by swelling, and occurs immediately after meals, sometimes before the patient is through eating.
Walking, and especially coming down stairs, aggravate this pain, and make it unbearable. Sometimes it extends to the bladder and perineum. It is ameliorated by sitting, and especially lying down.
Vomiting of food soon after meals is characteristic of Bryonia. The vomit sometimes is bilious, or composed of water, or even blood.
Doses: The 6th and 12th dilutions are most frequently indicated.
Pulsatilla.-Aggravation by fatty food, and aversion to fat, milk, butter, meat, and hot food, rancid taste in the mouth or that of spoiled meat; eructation acid or of rancid taste; pyrosis; bilious vomiting; vomiting of food ingested several days before, which is a sign of dilatation of stomach, and which is frequently accompanies dyspepsia. Pains are sometimes relieved by eating.
There is usually a great aversion to drinks. Diarrhoea and undigested stools are characteristic of Pulsatilla.
China-Cases of dyspepsia produced by the abuse of quinine are of frequent occurrence. We should not be at all surprised to find this remedy to be a powerful therapeutic agent in this affection.
The following characteristic symptoms indicate the use of China: Weight, slow digestion, with eructations, and rumination, sensation of fullness, sometimes disappearing on eating, and at other times it returns by the smallest meal. Appetite is compatible with this disease. Gastric flatulency is characteristic of this remedy. It is therefore well indicated in gouty dyspepsia.
Diarrhoea, especially right after eating, sleepy feeling, weakness of the limbs, dread of motion, despondency, hypochondriasis, are symptoms which call for China.
Doses: The 6th dilution has given me the most success, but there are cases where we should use lower or higher doses.
Carbo vegetabilis is indicated in the treatment of very chronic dyspepsia in the old. There is usually much flatulency, acidity, and sour eructations, headache and vertigo, rarely constipation. To these symptoms tympanites and painful hiccough should be added.
Doses: The 12th and the 30th dilutions.
Lycopodium-Intestinal flatulency, with constipation, irresistible drowsiness during digestion are good symptoms indicating this drug. Great belching of tasteless wind. Sharp pain during digestion of food, gastric weight relieved by the smallest amount of food, are less certain signs. Vomiting of food or bile, fullness soon after eating. A deposit of excess of urates in the urine is also a symptom calling for Lycopodium.
Doses: Twelfth and 30th dilutions.
Lachesis has been little used. Its only indications are extremely painful sensation on pressure over the epigastrium, tightness of the clothing, which is unbearable. Furthermore there is dyspnoea, palpitation, vertigo, headache, weakness of the limbs, and diarrhoea.
Baryta carb produces a very characteristic dyspepsia: fullness of the stomach, relieved by eructations, and which, like that in China, sometimes disappears after breakfast; acid regurgitation; nausea; ptyalism; frequent vomiting of mucus; pain at the cardiac end on swallowing. Difficult breathing, cephalalgia, general debility.
Antimonium crudum is indicated in dyspepsia with diarrhoea or undigested. stools, coated tongue, and loss of appetite. There are sometimes violent pain in the stomach, nausea, bitter and noisy eructations, hiccough, vomiting, lassitude, weight and sleepiness after meals.
Latent or Marked Dyspepsia.- The principal remedies of this variety are Tabacum, Carbo veg., Sepia., Natr. Mur., China, Hydrocyanic acid, Spigelia and Cactus.
Tabacum usually produces dyspepsia in smokers; it causes palpitations and irregular pulse. It is, therefore, well indicated in the treatment of cardiac dyspepsia. Clinical experience confirmed this indication of its pathogenesis.
Doses: The 6th dil. given four times per day gave me the best result.
Carbo Veg.-We just studied its indications in the preceding variety. It is particularly indicated in the cardiac variety, because it makes the heart intermit on lying down, and produces dyspepsia, which is accompanied by irregular beating of the heart with colics.
Clinical experience has in such cases more than once demonstrated its palliative action and occasionally its curative action.
Doses: Twelfth and 30th dilution.
Sepia is indicated when dyspepsia is accompanied by cardiac intermittence after meals, which is very characteristic of the masked cardiac dyspepsia. Pulsations at the epigastrium, colic with diarrhoea, even during meals, extreme lassitude, will cover the indications of this drug. These indications have been confirmed by clinical records.
Doses: The lower trit. and the high dilutions have been successfully administered.
Natrum Muriaticum.-In toxic doses sea salt produces death by cardiac paralysis. In small doses it produces palpitations of heart, with anxiety, intermittent pulse, and syncope. This drug produces a true dyspepsia: weight, swelling after meals, nausea, regurgitations (acid or bitter), pyrosis, great weakness, with drowsiness and redness of the face.
Doses: The 30th has given some good results. I have seen a very good result from the 200th dilution.
Hydrocyanic acid is recommended in palpitations caused by dyspepsia. This remedy is good for gastric affections which in some of their symptoms resemble cardiac affections which in some of their symptoms resemble cardiac affections. In the pathogenesis of this acid we find pressure and constriction in the pit of the stomach, with oppression; coldness in the stomach and intestines; nausea and vomiting; palpitations and irregular beating of the heart; weakness of heart beats.
Spigelia is the principal remedy in cardiac affections characterized by the irregularity and intermittence of the pulse.
Cactus produces a dyspepsia more characterized than Spigelia; slow digestion great weight on the stomach, oppression, acidity, very painful throbbing of the coeliac plexus and of temporals. Irregularity, intermittence of pulse, and palpitations are also produced by Cactus, and justify its use in the cardiac variety of dyspepsia.
Ignatia, Argentum Nit., Abies nigra, Carbolic acid, Acid. sulph, should also be thought of.
Ignatia is indicated when, with hysterical symptoms, which predominate, there is belching with pressure in cardia; regurgitation of the ingesta; eructation of a bitter fluid; nausea without vomiting; empty retching, better by eating; spasmodic gnawing; cutting pains in stomach, relieved by eating; spasmodic gnawing; cutting pains in stomach, relieved by eating, heaviness and pressure in the pit of stomach; bloated stomach. Distention of hypochondria and pit of stomach-so full can hardly breathe.
Dose: The 6th has always been sufficient in my hands.
Argent. nitr., like Ignatia, finds its place in flatulent dyspepsia, particularly in hysterical women, and in those who suffer from haemorrhoids; when everything seems to turn to wind; and there is constant and loud belching. Stomach and abdomen much distended, as if they would burst, a symptom often met with during menopause.
Dose: The 30th dilution always suffices to effect a cure.
Abies Nigra.-Continual distress about the stomach, as if everything knotted up; sensation as of an undigested hard-boiled egg in the stomach. Pain after a hearty meal.
Carbolic acid.- In fermentative dyspepsia, with bad breath and a bad taste in the mouth; acid eructations; sweet, bitter, or sour regurgitations; pyrosis; vomiting.
Acidum Sulph.-Dyspepsia with fermentation; vomiting of a substance resembling yeast; deficiency of acids in the system.