In young adults of both sexes the most common cause of gastric hyperacidity is pyloric spasm, associated with subacute or chronic inflammation of the appendix or gall-bladder, or both. This hyperacidity is not infrequently complicated by hypersecretion. These facts have been established by my personal study of 7,041 consecutive test-meal analyses at the Mayo Clinic and at Augustana Hospital. In 2,183 cases operative proof, with consideration of the postoperative course, was possible.
On account of clinical symptoms and signs, this group of cases is frequently confused with, or diagnosed as, "medical" gastric ulcer of the young. The clinical manifestations are: acid dyspepsia, epigastric distress and tenderness, occasionally nausea and vomiting, fluctuations in appetite, anemia and "hunger pain." Test-meal examinations of such patients generally reveal intermittent gastric stagnation (4 per cent.), hyperacidity and, if the ailment has persisted for an average time of 2.8 years, hypersecretion, periodic or continuous.
SMITHIES F. A NEW FLUOROSCOPIC SIGN FOR THE DIFFERENTIATION OF PYLORIC SPASM OF EXTRAGASTRIC ORIGINFROM THAT ASSOCIATED WITH UNCOMPLICATED GASTRIC ULCER ON OR NEAR THE LESSER CURVATURE. JAMA. 1914;LXII(17):1308–1309. doi:10.1001/jama.1914.02560420014007
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