Burning sensations at the epigastrium, followed by scalding in the chest and throat and the regurgitation of an acid fluid which sets the teeth on edge, are much less frequent in carcinoma than in simple ulcer of the stomach. They are apt to occur, however, as an early symptom of pyloric stenosis, and even after vomiting has set in regurgitations of acid may accompany the attacks of flatulence. The symptom is most common during the night, and is relieved by emesis. It is due to excessive fermentation of the retained food, whereby lactic and butyric acids are produced in large quantities, which give rise to irritation of the stomach.
Water-brash is a frequent symptom, especially when the cardiac end is the seat of the growth, and sometimes precedes the other indications of disease by several weeks. It often occurs in the intervals of digestion, or just before a meal, and is accompanied by a constrictive pain at the epigastrium and the regurgitation of an ounce or two of thin insipid fluid. Sometimes severe pain is experienced in the chest and between the shoulders, or the attack is accompanied by palpitation. The fluid itself is neutral or alkaline in reaction, and consists almost exclusively of saliva. The pain and regurgitation probably arise from a spasmodic contraction of the oesophagus.