Functional stomach diseases (neurosis of the stomach)

The so-called functional disorders of the stomach kortiko-visceral origin, or, in the terminology of some authors (C. O. Bodylines, 1958; O. L. Gordon, 1959), neurosis stomach essentially not represent a separate nosological forms. They are simply a manifestation of functional diseases of the Central nervous system, often neurasthenia, rarely psychasthenia, hysteria.
Although the literature has long highlighted the questions about the essence of functional diseases of the stomach, for a wide range of practical doctors these questions to date represent the known difficulties. In terms of drinking and balneological resorts neurosis stomach occur much more frequently than they typically diagnosed and appear in the medical reports. The reason is that due to certain difficulties in the differential diagnosis between neurosis stomach and chronic gastritis first of these diagnoses is little. Special studies (P. L. Bloch, 1957) showed that among sent to the resorts of patients diagnosed with chronic gastritis at least 25% of them have only a neurosis of the stomach, in most cases, as a manifestation of General neurotic state. We have established that for the diagnosis of this disease is the leading value has a specific set of clinical and laboratory signs. These include: the development of diseases after acute or chronic psychological trauma, the presence of functional disorders of the Central nervous system, young age of the patients is relatively small, the disease duration (up to 3 years b), the originality of clinical syndromes (phenomenon of acidity, gastralgia, and the conditioned reflex vomiting, aerophagia), low dependence of clinical manifestations of the nature of power, communication exacerbations with adverse neurogenic factors (often seasonal exacerbations), mainly hypersecretory, hyperacid and hyperkinetic disorders of the stomach, lack of or weak expression and the instability indices of inflammation in the stomach (normal or near normal content of mucus, leukocytes, biuret products). Functional disorders of other organs and systems, often a dyskinesia of intestines and bile ducts, cardialgia, labile hypertension, hypotension, etc.
In therapy of neurosis stomach S. O. Bazilikas (1958) takes the therapeutic factors of drinking and balneological resorts secondary role, and gives preference to restorative treatment in conditions of a favorable climate, beautiful landscape, etc., But the author does not deny the positive value of the internal intake of mineral water, especially when irritative phenomena in the stomach and the beginning of secondary inflammatory lesions. Spa treatment has a very beneficial effect on the course of functional disorders of the stomach in patients with nervous condition, and prevents the progression of the disease and the development of secondary gastritis, and in many cases gives lasting cure (R. L. Bloch).
The leading role in neuroses stomach belongs to curative factors, which help improve the condition of the Central nervous system and kortiko-visceral regulation. In the resort include the right of sanatorium-resort treatment, therapeutic exercises, climatotherapy, external use of the healing waters as public baths (especially radon), physiotherapy, etc., Diet therapy should provide a combination of moderate and short, the sparing of the digestive system with systematic training them.
Local heat treatments including mud applications, neuroses, stomach in most cases not shown; only when the development of secondary gastritis they can be used, but by attenuated method - at temperature of 38-40 degrees and in alternation with baths.
An important place in the resort complex therapy of patients with neurosis stomach occupies the internal use of mineral waters. Indications to it are clinically symptomatic pathology of the stomach (the phenomenon of acidity, gastralgia, and the conditioned reflex vomiting, aerophagia, and others), significant changes secretory and movement functions of stomach disorders of the intestine and bile ducts (dyskinesia), signs of incipient inflammatory or degenerative lesions of the mucous membranes of the digestive tract.
In table. 4 schematically outlined the principles of differentiated use of mineral waters for neuroses, stomach, depending on the nature of functional disorders of the stomach and the nature of the clinical manifestations of the disease. Because neurosis stomach often occurs with increased excitability of secretory and motor functions of him and the phenomena of so-called irritation of the stomach, the highest value in these States have water, that gentle influence on mechanical-, chemo - and thermoreceptors of the stomach. This is weakly mineralized, mainly hydrocarbonate water with a neutral or slightly alkaline reaction. If leading the clinical signs characteristic phenomena of acidity (persistent heartburn and acid regurgitation, worse after eating candy) or syndrome gastralgia (pain "late", "Hungry", night, calming after a meal, not depending on the action of mechanical and chemical food stimuli and so on), mineral water appoint 200 ml per reception 1.5 hours before meals; very persistent pain and heartburn that occurs at the height of digestion, it is recommended that the additional intake 50-100 ml of mineral water in 1 - 1,5 hours after a meal. In these cases, and especially at night pains apply microclysters of 100-150 ml of water temperature 38-39° at night before sleep.
If hypersecretory and hyperkinetic disorders of the stomach are accompanied by so-called conditioned reflex vomiting (frequent vomiting, not only after meals, but also at action of conditional stimuli: the sight and smell of food, talk about food and so on), are recommended mineral water with a predominance of chlorine ions. Drinking water treatment is low-method - mineral water is appointed by 100-150 ml per reception for 1,5-2 hours before meals; widely shown absorption microclysters of 100-150 ml of water and drip enemas from 0.5 to 1 to 1.5 liters, and gastric lavage with mineral waters.
In those relatively few cases where the neurosis of the stomach flows to the oppression of its secretory and motor functions (functional achlorhydria and ahilia, hypotension and hypokinesis), recommended water of medium mineralization with a predominance of bicarbonate ions, chlorine, sodium, containing carbonic acid in high concentrations and have different reaction from acid to alkaline. If hypotension and hypokinesis stomach also shown drinking mineral water containing radon. Mineral water is often prescribed at 200 ml 3 times a day for 15 to 30 minutes before eating. With significant inhibition of motor activity of the stomach and the sign of failure of its evacuation function of the drinking cure limit - dose mineral water reduce up to 100-150 ml per reception. Additionally appointed gastric lavage with mineral water, preferably at night before sleep.
For neurosis stomach very characterized by significant fluctuations of gastric secretion, which is expressed in the fact that one and the same patient hypersecretory and hyperacid stomach disorders periodically replaced by hipocrecia and oppression acid generating up to ahlorgidrii. In addition, many of the patients have mentioned above dissociation salootdelenie, acid-forming and motor function of the stomach: hypersecretion can be combined with anatsidnyh state, hipocrecia - with hyperacid disorders, anxiety salootdelenie and acid-forming functions of the stomach - with hypokinesis his etc.
In such cases can be useful weakly mineralized hydrocarbonate water with an average concentration of carbon dioxide.
As with nervousness stomach very often functional disorder of the intestines and bile ducts (mainly dyskinesia), in complex treatment included rectal administration methods of mineral waters - intestinal shower, siphon and underwater washing intestines, as well as therapeutic tyubazhi.