Hypochlorhydria is a diminution in the amount of hydrochloric acid. Physicians often administer hydrochloric acid about one half hour to an hour after the meal.
Many advocate a diet omitting protein, but since protein foods stimulate the flow of gastric juices, they should not be omitted, but used a little less freely.
Achlorhydria. Where there is an entire absence of hydrochloric acid, as in Achlorhydria, the stomach, of course, cannot digest proteins and this digestion must be done entirely by the trypsin of the pancreatic juice. The presence of liquified protein as beef juice in the stomach, however, acts as a stimulus to the gastric juice and is an agency in again starting its flow.
The foods should be liquid, so as to pass through the stomach without irritation. Clear milk must be excluded, because of the action of the rennin in coagulating the casein. This would irritate the stomach.
Peptonized milk, described on page [245] may be used as an article of diet,—also milk with limewater, gelatin, cream, olive oil, gruels, and any foods which would pass through the stomach in a liquid state. Any cereals must exclude the bran and must be masticated to a pulp, so that they may readily pass into the small intestine.
Dilation of the Stomach results from continued overeating, (especially when the nerves are weak), or eating when over tired. The muscular walls become so weak that they fail to contract. Peristalsis is likewise weak and the food, failing to digest promptly, ferments and forms gas. A dilated stomach is larger and its weight and weakness cause it to prolapse.
In the prolapsed condition the pyloric, or lower orifice of the stomach, is often nearly closed, partly by reason of its position and partly by the weakened folds of the stomach walls. Because of this obstruction to the free emptying of the contents into the duodenum, it is imperative that the food be masticated to a pulp and thus mixed with saliva, that the salivary digestion of starches may be complete in the stomach; or, at least, that all foods be reduced to a liquid state in the stomach. A chunk of food could not easily pass through the pylorus. All liquid or semi-liquid food should be held in the mouth until it, also, is mixed with saliva. The stomach should not be overloaded with either food or water and for this reason six meals a day, of light feeding, is best.
A dilated stomach does not necessarily indicate that the digestive juices are not secreted in normal proportions and easily digested proteins need not be avoided. It is desirable to furnish the proteins in concentrated form, as in meats, so as to get the most nutrition with the least bulk. Milk may be used, with limewater, if sipped slowly and held in the mouth until mixed with saliva.
Sugar should be used very sparingly, because it ferments readily and aggravates the distension. If it is evident that fermented products are in the stomach, it should be washed out with a stomach pump.