CONTENTS

• EXPLANATION
• THERAPEUTIC OPTIONS
• FURTHER ASSESSMENT
• DOCUMENTATION
• TRADITIONAL OSTEOPATHIC PERSPECTIVE
• THE ABDOMINAL AND PELVIC BRAIN

    In over 120 readings, Edgar Cayce cited abnormal stomach position as a contributing factor to serious systemic imbalances.  Typically, the readings use expressions such as "tilted," "tipped," or "dropped" when referring to abnormal stomach position.  In general, two patterns of abnormality are discussed:

• The stomach position may allow food to pass through too quickly without allowing proper digestion.  The stomach is too vertical with the upper portion (cardiac) too high or the lower end (pyloric too low).

• The stomach position may hold foods too long producing too much fermentation.  The upper end (cardiac) is dropped or the lower end (pyloric) is raised.

• Poor digestion and assimilation,
• Poor eliminations as poorly digested food is passed into the intestinal system,
• Disturbed circulation,
• Abnormal acid/alkaline balance,
• Abdominal symptoms including stomach pain, feelings of heaviness after eating, etc.
• Unbalancing of hepatic system functioning, primarily the liver, resulting in systemic toxicity and related problems.

• Charles Hazzard, D.O. - The Practice and Applied Therapeutics of Osteopathy (1905)

• Byron Robinson, M.D. - The Abdominal and Pelvic Brain (1907)

    Here are some therapeutic interventions frequently recommended by Edgar Cayce in cases involving abnormal stomach position.
 

MANUAL THERAPY

    One of the most frequent therapeutic recommendations for abnormal stomach position was spinal manipulation and massage.  Special attention should be given to the nerve centers which provide impulse to the stomach at the second to six thoracic vertebrae.  Direct abdominal manipulation to reposition the stomach may be helpful if the clinician has been trained in such techniques.
 

STOMACH SUPPORT

    A support belt or bandage was often recommended to help reposition the stomach.  For example, in reading 3607-1, a woman was told to "use an elastic belt to support the abdomen and the stomach itself.  Or still more preferable, though it would be much more trouble to use, bind heavy gauze about the body.  This would necessarily be done daily, and that it be taken off when the treatments of the osteopath are given."   For severe cases, the belt or support may need to be worn for several weeks or until a stomach position has been achieved.
 

EXERCISE

    In addition to moderate general exercise (such as walking), specific exercises were sometimes suggested to strengthen the muscles supporting the stomach.  Reading 848-1 provides typical recommendations for exercise and support belt to correct abnormal stomach position.  This reading suggests each morning and evening the individual bend forward with a circular motion of the body, circling the body for 5 - 15 minutes.
 

ELECTRIC VIBRATOR

    The electric vibrator was recommended in several readings for persons with "dropped stomach."   In these cases, food often stays in the stomach too long producing an uncomfortable sensation.  Using an electric vibrator directly over the stomach can stimulate peristaltic action and assist the stomach in moving the food along.  Also, use of the electric vibrator along the spine (especially at the 4th, 5th, and 6th thoracic centers) may be helpful in stimulating the nerve centers governing the stomach.
 

REST

    To balance the exercise and assist with healing, periods of rest while in a reclining position with the feet raised above the stomach was sometimes suggested.
 

DIET

    Usually a balanced diet with an emphasis on alkaline-producing foods.  If the individual is suffering from general debilitation and low vitality due to poor assimilations, vegetable and beef juices may be helpful.
 

DIGESTIVE AIDS AND NUTRITIONAL SUPPLEMENTS

    A variety of digestive aids and nutritional supplements were recommended to address the functional imbalances related to abnormal stomach position.  For hypoacidity, Acigest  (a product containing hydrochloric acid) was sometimes prescribed (usually taken in conjunction with Calcios, a calcium supplement).  Other frequently recommended digestive aids included lactated pepsin and milk of bismuth, and Alcaroid.  Yellow saffron tea and slippery elm bark water were prescribed in several cases involving abnormal stomach position.
 

HYDROTHERAPY

    Frequently, digestive problems originating in the stomach compromise the functioning of the entire intestinal tract resulting in constipation and other chronic bowel problems.  Colonic irrigation was recommended in numerous readings for persons with abnormal stomach position to assist in cleansing toxins from the lower GI tract.

    The abnormal stomach position scale may be used for screening for further assessment.  Further assessment options may include:

• Abnormal stomach position may be assessed by careful palpation of the abdomen.
• Imaging techniques (such as barium swallow and ultrasound) may be helpful in assessing for this problem.
• History of stomach injury (such as a blow to the stomach) or spinal injury to the second to sixth thoracic vertebrae may be significant.
• Physical examination of the spine with special attention to the second to sixth thoracic vertebrae may also be useful in locating somatic dysfunction associated with abnormal stomach position.

[NOTE: The following discussion of "enteroptosis" which includes dropped stomach (gastroptosia) comes from The Practice and Applied Therapeutics of Osteopathy by Charles Hazzard, D. O. which was published in 1905.]
 

ENTEROPTOSIS

    Enteroptosia is a disease in which various of the abdominal and pelvic viscera leave their natural positions, slipping downward into the abdominal and pelvic cavities.  It is a common and distressing complaint, frequently overlooked or not recognized.  It is sometimes regarded as a symptom group, but may, from the osteopathic point of view, be regarded as an idiopathic condition, due to specific lesion.
    These cases are often treated for some one feature, as for nervous dyspepsia, constipation, operation for floating kidney, etc.  It is a common error to overlook the essential condition of the disease.  The Osteopath who gives close attention to a class of neurasthenic, flat-chested, constipated patients, who complain of lack of bodily and mental vigor, many and various indefinite nervous symptoms, abdominal pulsation, vaso-motor disturbance, etc., will find most interesting material.  The multitude of symptoms may vary greatly in different cases, but the presence of neurasthenic conditions, altered thorax and spine, and unnatural abdominal condition, either of walls, viscera, or both, will usually afford an unmistakable sign of the disease.  After a little experience with such cases one learns to recognize them at a glance when presented for examination.  Once seen these cases can hardly be mistaken, and a few moments examination reveals a story of disease beginning imperceptibly, the growing conviction through many months or some years that something was wrong, the attempt to seem well because no decided disease seemed present, or a long course of treatment for various ills, none of which reached the true condition.  This most common disease it still but seldom clearly recognized or intelligently handled.
    LESIONS AND CAUSES: The common description of its etiology is unsatisfactory.  Tight lacing, traumatism muscular strain, and repeated pregnancies are mentioned.  The condition of relaxed abdominal walls and prominent viscera due to repeated pregnancies may probably be rightly regarded as a separate condition.  It is due to a physiological act, and does not present those specific lesions nor the resulting symptoms found in neurasthenic enteroptosis.  Tight lacing, traumatism, and muscular strain may produce those lesions found to be the cause of such conditions.
    These cases commonly present spinal, rib, diaphragmatic and abdominal lesions.  Spinal lesions may be of any of the kinds found in the spine ordinarily, and may occur anywhere along the splanchnic or lumbar region.  Rib lesions may occur in any or all of the lower six ribs on either side.
Mobility of the tenth rib is regarded by a German physician, Dr.  B. Stiller, (Phil.  Med.  Journal, Jan. 13, 1900,) as a pathognomonic cause of enteroptosis (Boston Osteopath, Jan. 14, 1900).  Undoubtedly it could interfere with the sympathetic connections of the abdominal viscera and become a factor in causing this condition.  But, from an osteopathic viewpoint, lesions of other ribs, and of spinal vertebrae, etc., may be as potent in producing the "basal neuropathy" concerned in this disease as its fundamental pathological condition.  Further, rib lesions may cause a condition of the diaphragm in which its normal tone is lost, and prolapse in it causes ptosis in the abdominal organs which it aids in supporting.  Spinal lesions may participate in causing the atonic condition of the diaphragm.
    Spinal and rib lesions, aside from derangement of the diaphragm, act to produce enteroptosis by interfering with the spinal sympathetic connections of the viscera and of their omental supports.  Impeded circulation and nerves supply, vaso-motor, motor, secretary, trophic and sensory produces at the same time derangement of function in the organs and weakness in their mesenteric supports.  These conditions work together to bring about the disordered function and the displacement of these organs.  The displacement of itself furthers the present bad conditions by mechanically interfering with the activities of organs, stretching nerve fibers and blood vessels which are carried in the now elongated omenta, kinking the colon at various points, etc.  The viscera, having sunk down into the abdominal cavity, cause prominence of the lower abdomen, leaving a hollow in the upper abdomen, thus giving to it the peculiar boat-shaped appearance described as "scaphoid abdomen."
    Lower dorsal and lumbar lesion may interfere with the spinal innervation of the abdominal walls, cause them to lose their tone and to dilate.  Intra-abdominal pressure is thus lessened and the organs are allowed to prolapse.
    According to Byron Robinson, enteroptosis begins with a weakening of the abdominal sympathetic, which loses its normal power over circulation, secretion, assimilation and rhythm.  That this weakness of the abdominal sympathetic and its consequent loss of function originates in spinal lesion to its origin in the splanchnic nerves has already been pointed out and fully discussed in considering the diseases of the stomach and intestines, q. v. The anatomical relation of such lesions to parts affected was pointed out.
    The PROGNOSIS in these cases is very favorable, but the progress of the cure is likely to be slow.  Generally improvement begins immediately upon treatment and may progress to a cure in a few months.  Other cases yield more slowly, though relief is soon given, and require an extended course of treatment to effect a cure.
    The TREATMENT must be both constitutional and local.  The latter consists in the removal of lesion and in abdominal treatment.  Lesions anywhere to the splanchnic and lumbar regions, to the ribs, thorax and diaphragm, must be treated after their kind, according to directions given in Part I. With spine, ribs, and diaphragm restored to normal condition, the underlying causes of the enteroptosis have been removed.  Corrected nerve and blood supply to the organs and their supports aids in correcting their function and strengthens the supporting tissues to hold them in place when restored by abdominal manipulations.
    Correction of spinal lesion also aids in restoring nutrition and tone to the relaxed and atrophied abdominal walls.  This process is furthered by a thorough treatment upon the abdominal walls.  This renders the use of the favorite abdominal bandage unnecessary, and it is gradually laid aside.  Throughout the course of the case the restored abdominal walls act as the bandage has done to hold the organs to their places as replaced by the treatment.  With corrected spine, free blood and nerve supply to all the visceral supports, and a strengthened abdominal wall, no difficulty is found in getting the parts to gradually be retained in their normal positions.  Thorough spinal stimulation over the splanchnic and lumbar; areas is kept up for the purpose of increasing the blood and nerve supply to the parts in question.
    Abdominal work, aside from treatment of the walls, is directed to raising and replacing the viscera.  This is readily accomplished by various treatments. (II, III, IV, Chap.  VIII.) This releases and renews circulation and nerve supply at the same time, removes pressure of organs upon each other, gives freedom of motion, and aids in strengthening the omenta to hold the parts in place.
The diaphragm has been restored to normal position, and tone by correction of those lesions originally deranging it.
    The constitutional treatment must be thorough and general to restore the patient from the nervous, circulatory, nutritional, and other effects of the disease.  A most thorough general spinal treatment must be given.  Thorough stimulation of heart and lungs, treatment of the cervical sympathetic, and attention to kidneys, liver and skin accomplishes the desired object.  The auto-intoxication usually present is overcome by this treatment of the excretory organs.  The constipation, dyspepsia, and other functional disorders are corrected by the restoration of the organs concerned.
    The patient should be much out of doors, free from worry, and careful not to become fatigued.  Deep breathing exercises are beneficial.

[NOTE: The following discussuion of "enteroptosis" which includes dropped stomach (gastroptosia) comes from The Abdominal and Pelvic Brain by Byron Robinson, M. D. which was published in 1907.]

Gastroptosia.

    Gastroptosia or atonia gastrica signifies abdominal relaxation.  It includes distalward movement of the stomach and relaxation of the abdominal wall.  It is a part and parcel of splanchnoptosia.  Gastroptosia (or its equivalent atonia gastrica) practically includes the terms dilation of stomach, ectasis ventriculi, insufficiency of the stomach, gastric insufficiency, motor insufficiency, ischochymia (retention of cbyme), myasthenia, extasis gastrica, because it signifies abdominal relaxation and relaxation includes dilatation and motor insufficiency.  Therefore gastroptosia is a proper, comprehensive, scientific term which signifies ptossi, dilatation and motor insufficiency of the stomach.  Gastroptosia is of paramount importance to physicians as its existence is frequent in every day practice.

    In early embryonic life the stomach is absolutely vertical and the child is practically born with a vertical stomach and besides I have observed scores of permanently vertical stomachs in adult autopsies (perhaps from arrest of development).  With the growth of the child the stomach rotates following the atrophying liver.  In the adult the rotated stomach is supplied on its ventral surface (left) by the left vagus and on the dorsal surface (right) by the right vagus.  Food aids by its weight and distention to force the stomach distalward.  In gastroptosia the lesser curvature and pylorus moves distalward.
 

Etiology.

    Gastroptosia arises from a variety of causes.  Disordered respiration with consequent descensus of the diaphragm and distorted distal thorax (ribs) is among the first disturbances.  In short gastroptosia coexists with splanchnoptosia.  Gastroptosia may be due to an abnormally distalward location of the diaphragm.  In hepatoptosia the liver forces the pylorus distalward and to the left. Relaxed abdominal walls, rapidly repeated pregnancies, infected puerperium (i. e., practically subinvolution of the abdominal wall), compression from waist bands, liver or spleen tumors, pleuritic effusions or adhesions, pericarditis are fruitful causes of gastroptosia.  I have observed in autopsies that peritoneal and especially omental adhesions play an extensive role in gastroptosia.

    Gastroptosia is congenital or acquired.  The acquired gastroptosia is discernible in the change in normal relations of the space in the proximal abdomen and distal thorax especially in the manifestation of respiration.  In general we observe at post mortems two forms of gastroptosia, viz.: (a) the whole stomach appears (with the lesser curvature and pylorus with a transverse position) moving caudal, (b) the distalward moving stomach assumes more or less a distinctly vertical position.

    I wish to state, that, from personal autopsic observation in the abdominal viscera in over 700 subjects, the stomach varies extensively: (a) in position, (b) in dimension, (c) in form.

    Gastroptosia may be due to constitutional defects or anomalies in both sexes.  The peculiar formed chest, as funnel shaped, chicken breast, may be observed in subjects with gastroptosia which is part and parcel of splanchnoptosia.  Gastroptosia occurs in subjects with tubercular habitus - constitutional defects.
 

    Gastroptosia (or splanchnoptosia) does not as a rule occur in strong robust subjects.  Obvious stigmata of degeneracy accompanying splanchnoptosia subjects with elongated narrow thorax are liable to gastroptosia because the diaphragm occupies an abnormally distalward location.  Pulmonary emphysemia or pleural effusions force the diaphragm distalward favoring gastroptosia (and concomitant splanchnoptosia).  Mechanical conditions may enhance stomachoptosia as supraumbilical hernia, inguinal or femoral hernia, peritoneal adhesions.  Rapidly repeated gestations present a large field of gastroptosia so fully discussed by Landau as well as rapid loss of large quantities of fat.  In multipara and subjects with loss of quantities of flesh the abdominal muscles become relaxed and lose their delicate active poise in maintaining the viscera in their normal physiologic position.

Gastric Dilatation in Splanchnoptosia.

    Many times I have observed in autopsy extensively dilated stomach, the existence of which in life had not been suspected, first, because the physical condition of the patient was favorable and second compensatory action between stomach and pylorus was still favorable.  A relation exists between the dimensions of the pylorus and that of the stomachs compensatory action.  I performed an operation on a woman who had vomited for years with a dilated stomach.  In this case the pylorus had dilated slightly and its flexion increasing by ptosis obstructed the free evacuations of the stomach contents.
 

    Again we note autopsies in which a subject possesses a markedly dilated stomach with slight difficulty in evacuation of stomach contents through the pylorus because the pyloric ring had dilated proportionately with the stomach dilatation allowing free evacuation, free passage of food from stomach to duodenum, free drainage - here is compensatory dilatation - of stomach and pylorus, resembling that of the cardiac valves, however, suddenly the stomach and pyloric compensatory action may fail and the patient passes swiftly onward and swiftly downward - exactly as in valvular heart lesions.

    The etiology of gastroptosia may be sought chiefly in constitutional defects.  However, mechanical derangement is sufficiently obvious in gastroptosia.  Gastro-duodenal dilatation which plays such an extensive role in splanchnoptosia will be discussed and illustrated in a future chapter.  Combined gastro-duodenal dilatation due to the compression of the transverse duodenal segment by the superior mesenteric artery vein and nerve is a frequent condition and though I have published articles on it for a decade it is still but limitedly recognized.   The symtomatology may be practically negative or of the most aggravated kind.  It may be stated, in general, that gastroptosia is without symptoms so long as the stomach functionates normally which mainly prevails while the subject is in favorable physical condition.  Gastroptosia presents symptoms when detention and composition food occurs and general infection results.  Indirect symptoms may arise as in splanchnoptosia, e. g., fatigue, debility, constipation, insomnia.  Meinert insist that gastroptosia is a common cause of chlorosis.
The symptoms of gastroptosia are generally proportionate to the degree of stomachic dilatation.  Kussmaul originally observed that gastroptosia is frequently accompanied by a disturbance of the motor nerves of the stomach.  This may be due to the trauma traction on the vagi from change of gastric position.  Gastroptosia frequently coexists with multiple nervous symptoms, but the nervous symptoms may be due to splanchnoptosia. However, gastroptosia is a disease and is liable to be accompanied by disturbed motion, absorption, secretion and sensibility of the stomach.  Change of form and position of the stomach may not lead to any more nervous symptoms than change of form and position of the uterus, however dislocation of the uterus, i. e., permanent fixation, is the result of some disease.

    Malposition of the stomach does not produce neurasthenia any more than malposition of the uterus.  The position of a mobile viscus is not responsible for neurosis, for mulitple positions or multiple deviations must not be considered abnormalities.  It is disease that produces neurosis, not position of viscera.  Original disease which produced the malposition of the viscus should be held responsible for the nervous disturbance.  Again there can be no doubt that the symptoms of gastroptosia and nephroptosia are constantly mistaken for each other especially by the careless examining surgeon with a tendency to nephropexy.  There is no characteristic stomach contents peculiar to gastroptosia.  In gastroptosia pain is generally prevalent in the proximal abdomen and 'Lumbar regions.  It is true that subjects with gastroptosia (a part and parcel of splanchnoptosia) present multiple neurotic symptoms simulating disturbed mobility, secretion, absorption and sensibility of the stomach.  However, this may belong in the congenital debility or predisposition of the patient - due to the disturbance created by anatomically dislocated viscera and consequently pathologic physiology.  Gastroptosia increases the weight of the stomach.

Diagnosis.

    Gastroptosia is less recognized than nephroptosia which is diagnosed with more facility and besides the pexyites are more vigorously in search of nephroptotic victims.

    Percussion and auscultation with various quantities of fluid in the stomach may suggest the position and dimension of the stomach.

    Palpable epigastric pulsation, absence of projecting abdominal wall in the epigastrium and projecting abdominal walls in the hypogastrium aid in the diagnosing gastroptosia.

    The most exact method to determine the position and dimension of the stomach is by inflation, viz.: (a) by generation of gas within the stomach.  The most frequent method of gastric inflation practiced is by directing the patient to drink a glass of water containing some sodium bicarbonate and immediately to drink another glass of water containing tartaric acid whence carbonic acid gas is formed distending the stomach by air. (b) Another method to inflate the stomach is by introducing into the stomach a tube whence air is forced through it for distention, whence its form, position and dimension may be observed through the abdominal wall. (c) A third method of diagnosing the form, position and dimension of the stomach is by distending the stomach by fluid.

    When the major curvature is at or below the umbilicus and the pylorus and lesser curvature have moved distalward the diagnosis of gastroptosia is confirmed.  A healthy stomach maintains the position of its borders regardless of the subject's attitude.  In gastroptosia the borders of the stomach change according to the patient's position.  In gastroptosia with the patient in the erect posture the major stomach curvature and pylorus will be more caudal, while if the patient's posture is recumbent the pylorus and major curvature cephalad.  Succussion (splashing sound) is a method to diagnose gastroptosia by agitating air and water in the stomach through shaking the body.  The splashing sound may also be obtained by palpating the stomach while the patient is in the recumbent position.  A splashing sound elicited from the stomach means practically gastroptosia-relaxation, atony.  Some persons by practicing pressure of the abdominal muscles of the stomach can produce various sounds in the stomach.  Such persons perhaps possess abnormally a large stomach and powerful abdominal muscles, however, like a fakir have exaggerated an anomaly.  Gastroptosia may be diagnosed by transillumination, i. e., introducing an electric light in the stomach whence its contour may be observed.  This method was advocated in 1845 by Casenave, later in 1867 Milliot improved it by experimentation, however, Dr. Max Einhorn of New York practically first made successful use of (the gastrodiaphane) transillumination of the stomach in man and demonstrated the utility of gastro-diaphanes copy.

    Inspection may present a depression in the epigastrium and a projection in the umbilical region.  This method of diagnosis may be sufficient in spare persons to announce gastroptosia.  The X-ray may be used to note the position of the stomach by administering substances which will cast a shadow, as subnitrate of bismuth or metallic salts administered in capsules.  Treatment is medical, mechanical, surgical.

Treatment.

    1.  The medical treatment consists in regulation of diet and function.  The dietetic management consists in administering limited quantities of prescribed food at regular three-hour intervals.  The diet should be cereals, vegetables, milk and eggs.  All high seasoned food, pastry, pie, cake, spices, meat should be excluded to avoid fermentation.

    The most essential medical treatment consists in "visceral drainage" as ample sewerage the evacuating channels should be flushed.  Gastroptotics may live healthy with ample visceral drainage.  The tissues and tissue spaces in gastroptosia (splanchnoptosia) require flooding, washing, so that the subject may be free from waste laden blood and residual debris.  Every evacuating visceral tract (tractus intestinalis, perspiratorius, urinarius respiratorious) should perform maximum duty.  The sheet anchor treatment for gastroptosia is regulation of food and fluid, and maximum sewerage of visceral tracts.  Dietetics, hygiene, anatomic and physiologic rest, properly supervised tend extensively to the welfare in the life of a splanchnoptotic.
 

    Mechanical treatment in gastroptosia judiciously applied affords wonderful relief.  Stomachic irrigation occasionally renders much comfort.  The treatment consists in the application of abdominal wall to support the viscera.  This is accomplished by various kinds of abdominal binders - elastic and non-elastic.  I use sometimes an abdominal binder within which is placed a pneumatic rubber pad which is distended with air to suit the patient's comfort.  Dr. E. A. Gallant employs a suitable fitting corset.  The adhesive strapping method of Achilles Rose is practical, rational and economical and affords excellent relief.  The recumbent position aids the patient. The mechanical method attempts the forcible reposition of the stomach to its physiologic position and there to maintain it by aids applied to the abdominal wall - a rational method.  Pregnancy practically relieves the gastroptosia for a season.  Splanchnoptotics experience more comfort from rational adhesive strapping (mechanical supports) than from surgical procedures.

    Surgical treatment in gastroptosia is a very limited field.  It espouses two methods, viz.: (a) The surgery is applied to the stomach itself as gastro-enterostomy, the Heinicke-Mickulicz operation (both tend to cure by visceral drainage) the replication of the stomach parietes or the attempt to shelve the stomach by omentum or mesentery (both unphysiologic, irrational).  (b)  The abdominal wall is employed to support the stomach as by incision and over-lapping like a double breasted coat, or by enclosing, uniting the two musculi recti abdominales in one sheath.  Both methods attempt to relieve by lessening the abdominal cavity and forcing the stomach into its normal physiologic position (both rational).  A third method is to perform gastropexy, i. e., suture the stomach to the abdominal wall (limited, irrational in general).