EPIGASTRIC PAIN AND ITS HOMOEOPATHIC TREATMENT


EPIGASTRIC PAIN AND ITS HOMOEOPATHIC TREATMENT. The patient always complaints of epigastric pain and in his painful crisis can very seldom determine the irradiations that it produces on him; therefore, the physician is obliged to investigate in order to establish the differential diagnosis and prognosis of each individual case.


Read by title, Bureau of Clinical Medicine, I.H.A., July 23, 1954.

From the aggregate of symptoms and lesions, from the functional and psychical of the patient, the clinician deduces his pathological diagnosis and his therapeutic indications.

Epigastric pain is a symptom of the highest importance in gastric semeiology which appears in different diseases of the digestive apparatus and annexes. It is a viscerosensory reflex with characteristics and radiations, timing, rhythm, periodicity and modalities that must be known and appraised in all other details.

From the therapeutic point of view, before making a prescription for the epigastric pain symptom, it is indispensable to make a diagnosis which allows us to determine with precision the original cause of this “symptom,” in order that the curative results may answer to a right prescription of cause and not of effect.

One must not forget that patients react to pain in very different way and always according to their own sensibilities and temperaments.

In reference to the interpretation of the pain symptom, one has above all, to discard dissemblers, hysterics and toxicomaniacs.

Epigastric pain must be classified into acute and chronic from the clinical point of view.

In acute epigastric pain one must take into account: 1) the manner of its beginning, 2)duration, 3)peculiar character of the pain, 4) intensity, 5) localization, 6) irradiation and reflex points, 7) conditions which calm or make the pain worse, 8) relation with other symptoms and 9) seriousness of the clinic situation.

The cases which bring about a painful crisis in the epigastric region are very different and for their immediate diagnosis a very keen clinical criterion is necessary in order to determine if this pain, which generally is situated at the level of the xiphoid appendix or periumbilical zones sometimes spreading to the right side, left hypochondrium or pelviabdominal zones, is the cause or effect of functional alterations or lesions that do not precisely belong exclusively to diseases of the stomach.

The patient always complaints of epigastric pain and in his painful crisis can very seldom determine the irradiations that it produces on him; therefore, the physician is obliged to investigate in order to establish the differential diagnosis and prognosis of each individual case.

The most frequent causes which produce acute epigastric pain are: emotional shocks, acute gastritis of diverse etiology, vesicular colic due to cholecystitis or cholelithiasis, cholangitis and cholecystitis, congestive hepatitis and hepatic abscess,, acute appendicitis, enterocolitis, stomach ulcer with perforation, hernia of the esophageal hiatus, strangulated epigastric hernia, intestinal occlusion, acute pancreatitis, coronary thrombosis, abdominal angina, aneurysm of the abdominal aorta, subphrenic abscess, acute lobar pneumonia, tabes dorsalis, Addisons disease, Henochs purpura and neuralgia origin.

In cases of chronic epigastric pain, one has to follow the same technique as in acute cases in establishing the differential pathological diagnosis which allows t he physician to formulate the right prescription for each case using all the means, the modern medical science advise, such as functional proofs, investigation or gastric juice, duodenal sounding, X-ray photographs of the stomach and gall bladder, examination of the feces, etc., etc. Besides, one must not forget, in the same manner as in acute epigastric, pain, to consider the beginning, duration, character, localization, etc., etc., of the chronic pain.

The most frequent causes of chronic epigastric pain are: hyper-and hypotonic dyspepsias, hyperchlorhydrias, aerophagias, ptosis and gastroenteroptosis, gastritis and chronic gastroduodenitis, duodenal ulcer and those of the chest lesser and greater curvature of the stomach, stenosis, carcinomas, diaphragmatic hernia, cholangitis, biliary lithiasis, cholecystitis, renal lithiasis, leukemia, hepatic cirrhosis, splenomegaly, coliphagias, neoplastic lesions of the colon, pleurisy, tabes dorsalis, dorsolumbar spondylitis and epigastric pains of neuropathic origin.

The differential diagnosis of each one of these functional alterations or visceral lesions being established one has to take into account, besides the psychic state of the patient, the characteristics and modalities of the pain whether precocious, dilatory, ultra dilatory, permanent, rhythmic, discontinuous, intermittent, with or without vomiting, prandial and postprandial, pain without relation to the time of feeding, improvement, aggravations, etc., etc.,. in order to prescribe the correct dietetic, pharmacological, physical or surgical regime.

From the genuine Hahnemannian point of view, of have in the Homoeopathic Materia Medica, a very wide arsenal of remedies for acute or chronic epigastric pain, which allow us to reach the therapeutic ideal of morbid individuality and to obtain a quick, mild and lasting cure. (Cito, tuto et jucunde.).

According to my own experience I will mention the most frequent indicated remedies:

Colocynthis-Epigastric pain most intense and excruciating of spasmodic form and discontinuous type which appears after a violent emotion, a crisis of annoyance or indignation. In the same way this crisis can be originated by the ingestion of unripe fruits or very highly seasoned food. The pains are very intense and rending which obliges the patient to bend forward and press in upon the abdomen upon which he feels better. The pain is almost always propagated to the periumbilical and pelvic regions, becomes worse towards the left side; sometimes it is accompanied by nausea and vomiting with yellow greenish mucosity of a bitter taste. Constant sensitivity in the epigastrium which becomes worse or the touch. Diarrhea with mucous or blood stools, produced when ever the patient drinks water or eats food.

A distended and painful abdomen, aerophagia and flatulence with aggravation due to feculent food. From its action upon the solar plexus, lumbo-abdominal region and sacrum, Colocynth this is indicative in pelvic neuritis along with epigastric and umbilical irradiations.

In chronic cases: pains with a sensation of oppression as of stones or nippers in the stomach and which shows improvement upon pressing. Cramping pains which are propagated to the lower extremities.

AGGRAVATION – Through annoyances, violent emotions and farinaceous foods.

IMPROVEMENT – By pressure, warmth and by bending forward.

CLINICAL INDEX – Gastritis, gastrointestinal crisis of emotive origin. Cholangitis. Calculous and obstructive cholecystitis. Hyper – or hypotonic dyspepsias, aerophagias, flatulency through abuse of farinaceous food. Colitis and enterocolitis among children and adults due to transgression in the diet. Appendicular colic with epigastric reflex.

Magnesia Phosphorica – Violent, spasmodic, discontinuous pains which are spreading from the epigastrium to the abdomen, right flank and back. Very intense pains located upon the transverse colon compel the patient to bend double, relieved by strong pressure or massage, likewise with not applications.

Diffuse meteorism whether widespread or localized to the right colon, expulsion of belchings and gases that do not produce relief. Persistent hiccough with retchings day and night. Thirst for cold drinks; muscular contractions in different parts of the body; cramps in the lower extremities.

AGGRAVATION – Right side, at night through cold and too much touching.

IMPROVEMENT – Through pressure, by bending forward an by frictions.

CLINICAL INDEX – Vesicular colic due to cholecystitis. cholangitis, cholelithiasis, widespread flatulence, appendicular colic with a very intense epigastric pain of cramping form. Hyperacid colopathy, fermentative dyspepsia. Dysenteriform colitis and enterocolitis.

Cuprum Metallicum – Spasmodic, continuous epigastralgia preceded by hiccough and abdominal spasms, dark choleraic diarrhea, bloody with tenesmus and great emaciation. Nausea with vomiting that is improved upon drinking cold water. Intense metallic taste in the mouth, paralysis of the tongue. When the patient drinks water there is gurgling. A tense, sensitive to touch or contracted abdomen, paroxysmal; violent pains cramps of the stomach and abdomen.

Excruciating colic with stercoraceous vomitus, epigastric and umbilical pain in the form of cramps. In the course of choleriform gastroenteritis when there are intense pains and cramps.

AGGRAVATION – By vomit and pressure.

IMPROVEMENT – Though drinking cold water and transpiration.

CLINIC INDEX – Acute gastritis, Abdominal neuritis. Choleriform gastroenteritis. Spasms of the diaphragm with sudden blows to the thorax and abdomen. Hiccough with a sharp inspiratory sound. Spasm of the glottis. Epigastralgia with intestinal occlusion.

Belladonna – Red mouth, purple color of the tongue, inextinguishable thirst for cold water. Loss of appetite with aversion to meat and milk. Nausea and vomiting when finishing eating. Empty retching with constrictive spasmodic pains in the epigastrium which spread to the dorsolumbar region. Uncontrollable vomiting, great epigastric and abdominal sensitivity which any pressure makes worse, and the bed clothes and spreads are unbearable, the patient leans backwards checking breathing in order to feel improvement and is obliged to walk slowly or stop his march for fear of feeling worse. Epigastric and hypogastric burning, great sensitivity to touch and movement. Hiccough. Anxiety.

Higinio G. Perez