The treatment of dilated stomach varies according to the cause. The dilatation may be the result of obstruction at the pyloric end of the stomach - obstructive form - which is most commonly due to malignant disease, simple ulceration, or chronic inflammation with adhesions in and around the pylorus; or there may be dilatation with little or no pyloric obstruction - non-obstructive form - which may result from (a) a primary defect in the stomach itself, e.g. hyper-chlorhydria, or (b) from some general constitutional weakness, such as neurasthenia, anemia, tuberculosis, or other debilitating illness.

Dilatation Of Obstructive Origin

The treatment is here mainly surgical. If the cause of the obstruction cannot be removed, the dietetic treatment of the dilatation must be conducted along the lines to be hereafter indicated (p. 341).

Dilatation Of Non-Obstructive Origin

We have in the first place to keep in view the fact that the dilatation may be the result of a primary disorder of the stomach, or it may be merely an expression of the general want of muscular tone present in any debilitating illness.

The primary disorder of the stomach is most commonly of the nature of a chronic gastric catarrh resulting from excessive eating and drinking, and more especially from the injudicious use of alcoholic drinks; another common cause is hyperchlorhydria, which is frequently associated with a lesser degree of dilatation. Of the general diseases which induce dilatation of the stomach in varying degree, special mention should be made of neurasthenia, severe anemia, tuberculosis, and advanced renal disease; in these conditions the diet is adapted to the general disease; it is not as a rule necessary to pay special attention to the stomach itself.

Before considering the dietetic treatment, reference may be made to other points in treatment which bear directly on the question of food and its digestion. Complete rest in bed for two to three weeks is essential at the outset of treatment in severe cases. A septic state of the teeth is often an important predisposing cause, and sometimes an exciting cause of the gastric catarrh which has led to the dilatation; it is therefore essential that the teeth should be thoroughly attended to. An atonic condition of the bowel with constipation is a frequent complication of dilated stomach, and among the measures adopted to relieve this, special mention should be made of massage and physical exercises specially adapted to strengthen the tone of the abdominal muscles. Mild counter-irritation, by means of mustard plaster or small blisters, is often of great value. If there is evidence of an unusually septic state of the intestinal contents, as shown by marked foetor of the stools, this should so far as possible be corrected by the judicious use of agents which modify this, more especially the various preparations of lactic acid bacilli (p. 540). And, lastly, the use of lavage - washing out the stomach each night or every alternate night for a week or two, or it may be longer, is often of the greatest service in treatment. The removal by lavage of the numerous toxic fermentation products which accumulate in a dilated stomach leaves the mucous membrane in a healthier condition, and gives an impetus to a more satisfactory digestion of foodstuffs.

General Principles In Dietetic Treatment

The general principles of treatment are quite clearly defined. We must give the maximum of rest possible to the damaged organ. We must give the stomach as much rest as possible consistent with giving an amount of nourishment adequate to the patient's condition. This must be done by reducing the total bulk 0/ food, by diminishing the amount of solids in the dietary, and giving the food in concentrated form. For the same reason the liquids must be restricted, as they mechanically distend the stomach and over-dilute the gastric juice. In cases of moderate severity, not more than from 20 to 30 ounces of fluid should be taken in the twenty-four hours. All effervescing beverages should be avoided; and stimulants are as a rule contra-indicated.

At the outset, in very marked cases it may be advisable to give no fluid by the mouth, but relieve thirst by ice, and supply the requisite amount of fluid to the tissues by rectal injection of normal saline. Foods have to be of the unfertnentable variety. Farinaceous foods are therefore given in very restricted amounts, proteins forming the chief basis of the dietary., In this connection it is important to bear in mind that Lactose is an unfcrmcntable sugar, and advantage may be taken of this to supply carbohydrate in this form. Vegetables which are not readily converted into a semi-fluid or pultaceous form in the stomach should not be allowed; and as green vegetables come under this category their use has to be carefully restricted, and special precaution taken with regard to the cooking and the form in which they are presented. No stimulants should be given, such as alcohol, tea, coffee, spices, and condiments. Starchy foods should also be avoided. The meals should be small in amount and frequently administered, and in severe cases a complete hour's rest after meals should be enjoined. In the obstructive forms of dilatation which are not amenable to surgical treatment, peptonised and pancreatised foods are of special value (p. 171). Two illustrative dietaries are appended, suitable for a severe case under complete rest and a less severe case respectively.