Gastric neuroses include =motor=, =sensory= and =secretory=
derangements. Though the sensory disturbance is often the most marked,
still motor and secretory symptoms are usually present. In other words
there is commonly a complex of the different forms.
Where gastric neuroses can be positively diagnosed, by a process of
elimination, there is no more plausible explanation than that of the
spinal lesion. The success of osteopathic physicians in treating
so-called “stomach trouble” proves conclusively the superiority of the
osteopathic method. A note of warning should be sounded, however, for
as diagnostic methods have become more exact it is found that many
cases which were formerly diagnosed as neuroses prove to be referred
from some organic change, such as infected gall bladder, appendix, tube
or ovary, tonsil, tooth or sinus. It has been proven that many cases
of sensory and secretory disturbances have entirely cleared up when
these causes have been removed. Though infection may play an important
role, still in some instances, especially gall bladder, duodenum and
appendix, the gastric neurosis may be simply due to a nervous reflex.
Gastroptosis, atony, and in many cases splanchnoptosis, has been
found to be the underlying cause of many hitherto unaccountable
gastro-intestinal symptoms.
Gastric crisis of locomotor ataxia if not properly diagnosed by the
finding of the other well known symptoms may give us much trouble and
discouragement.
Ulcer and cancer have quite characteristic symptoms, yet it is well
known that they are often treated as neuroses in the early stages, much
to the detriment of the patient, especially if the case proves to be
cancer.
In the =sensory= disturbances, which are probably the most common,
hyperesthesia and =neuralgia= are the special features. In the former
a feeling of weight, fullness and burning are complained of, which are
frequently manifestations of a neurotic temperament. In fact, hysteria
and neurasthenia are very often basic conditions. The same is true
in gastrodynia, where the pain starts in the pit of the stomach and
extends around the lower chest and ribs. There may be other neurotic
symptoms such as excessive hunger and a constant desire for food.
Menstrual irregularities, the menopause, worry, constipation, and
anemia are important factors. Special care should be taken that there
is no organic disorder of the gastro-intestinal tract or of the nervous
system.
The =motor= neuroses comprise a variety of derangements. Excitation of
the motor functions of the stomach, as a direct result of irritated
nerves or of reflex stimuli, are not uncommon. Owing to this the food
may not remain in the stomach long enough or the stomach activity may
be too pronounced. There may be also more or less rapid vomiting of the
food, without any particular strain. Other motor neuroses may be spasms
of either the cardiac or pyloric sphincters, and in a few instances
there may be atony of the stomach walls. Although these conditions may
be of a neurotic character, still great care should be taken that some
organic disease is not basic.
The =secretory= derangements consist of hyperacidity, supersecretion,
and lessened amount of acid secretion or achylia gastrica. Many of
these cases are associated with hysteria and neurasthenia, though
in achylia gastrica, cancer may be the cause. Hyperacidity may be
associated with ulcer. Pelvic diseases, nervous reflexes from the
gastro-intestinal tract, constipation, and anemia are to be considered
as possible etiological factors.
=Diagnosis.=—These cases require the most painstaking inquiry into
the history, the most complete physical examination, and all findings
carefully checked up by laboratory tests.
Inquiry will often show that all symptoms subside when on a vacation
with a change of scene and climate.
Lockwood gives the following rules for arriving at a diagnosis of
“nervous indigestion.”
“(1) A diagnosis of nervous indigestion should not be made in the
presence of more than 30 c. c. of fluid in the fasting stomach, the
fluid giving a strong reaction for hydrochloric acid. Hypersecretion is
generally an expression of pyloric stenosis, organic or spasmodic, and
this is due to an organic cause.
“(2) A diagnosis of nervous indigestion should not be made in the
presence of persistent hyperacidity accompanied by epigastric pain.
Nervous hyperchlorhydria may occur, but is not accompanied by either
pyrosis or pain. The association of either of these latter symptoms
should suggest an organic origin for the complaint.
“(3) Achylia gastrica may be of nervous origin, but this is not
probable when serious motor error is in evidence. Achylia with
food-stagnation is strongly suggestive of cancer of the stomach.
“(4) Achylia gastrica, accompanied by pain or vomiting, indicates an
underlying organic cause.
“(5) The diagnosis of nervous indigestion should not be made when
recognizable food remains are repeatedly found in the fasting stomach.
Under the influence of fear, nervous shock, or vicissitudes of
temperament the motor functions may be temporarily interfered with, but
this would not be the case permanently.
“(6) The diagnosis of nervous indigestion should not be made when
epigastric distress or pain occurs regularly at a definite time after
eating. The very fact of this disturbance coming on at a definite time
argues against a neurosis.
“(7) The diagnosis of nervous indigestion should not be made when one
symptom alone persists, without other evidences of nervous instability.
The presence of one definite symptom in itself presupposes an organic
cause.
“(8) The physician should be on the qui vive for drug addictions, for
these habitues can sometimes present a syndrome of symptoms that will
puzzle the most experienced.
“(9) The diagnosis of nervous indigestion should not be made in persons
over forty or forty-five, in whom indigestion is a new symptom. Such
patients are usually developing a serious systemic or malignant
disorder.
“(10) Finally, digestive nervous neuroses and organic disease may be
concomitant, and the presence of either need not exclude the other.”
=Treatment.=—First get the patient’s confidence by making a most
complete examination. This desirable beginning is usually hastened by
the osteopathic physician, when after a few treatments symptoms are
greatly relieved. Correct all lesions wherever found, particularly
those anatomically connected with the stomach. When the symptoms are
sensory relief can always be given by inhibition over the splanchnic
area. Occasionally the ensiform process and the lower costal cartilages
are lesioned.
=Diet.=—When hyperchlorhydria is the chief symptom foods must be
selected which bind acidity or those which lessen its secretion, such
as milk, eggs, cream cheese, fats such as butter, cream, olive oil,
boiled or broiled fresh fish, =boiled= beef or lamb run through
a grinder, oysters in any form but fried, white meat of chicken,
vegetable puree made with cream or milk (no meat stock), gelatine,
custard, junket or =sponge cake=.
Many neurotic patients are under-nourished through fear of food.
They must be positively assured that if the food is well chosen and
carefully masticated there need be no fear of discomfort. Care should
be taken that the patient is not constipated.
Some cases can only be reached by a “rest cure” of four to six weeks,
which together with the treatment outlined above will prove most
satisfactory.
In all cases guard against worry and overfatigue. Build up the general
health as rapidly as possible. Outdoor life, sufficient sleep, frequent
vacations, and change of scene are specially beneficial.