The impact of epidemiology upon the diagnosis and management of gastric disease: the experience of the Hawaii JapaneseStemmermann GN.
Several conditions have been identified as precursors of gastric cancer. The most common of these is intestinal metaplasia (IM) accompanying atrophic antral gastritis (Type B gastritis) in countries at high risk for gastric carcinoma (Japan, Eastern Europe, Western South America). The risk for this tumor is acquired in youth and persists into old age even if the person migrates away from the high risk area. It has been linked to a diet containing large amounts of salt and nitrate; but lacking in Vitamins C and E. The next most common high risk condition is atrophic gastritis with IM of the oxyntic mucosa accompanying pernicious anemia (Type A gastritis). This disease is most common in Northern Europe. Carcinoma accompanying intestinal metaplasia is usually intestinal in type; and induction of both IM and cancer have been attributed to the action of nitroso compounds in the gastric juice. These could be formed by nitrosation of dietary amines, a process that is blocked by Vitamins C and E. Diffuse gastric carcinoma occurs in younger persons who have little or no IM. It is less responsive to environmental changes and is most common in patients with blood Type A. Such persons may have inherited increased susceptibility to environmental carcinogens so that a small dose could generate invasive carcinoma with no intermediate stage of IM, as may occur in experimental animals given large doses of nitroso compounds. If gastric carcinoma induction follows repeated mutagenic events, dietary intervention might arrest the process at the level of IM. This could take the form of daily use of Vitamins C and E, and reduced consumption of salt. Recognition of high risk groups might identify persons that might be usefully subjected to periodic endoscopic screening (e.g., every 5 years).
Acta Endoscopica 1981 Mar;11(2):103-22. PMID: NONE
LETTER TO THE EDITOR - Antacids, bile-salts, and colon cancerNomura AM, Stemmermann GN, Glober GA.
Sir, - Cruse et al.1 argue that aluminium hydroxide might promote cancer of the colon by increasing the delivery of bile-salts to the large intestine. Although their study with Wistar rats did not demonstrate that the increased mortality of rats treated with dimethylhydrazine and 'Aludrox' was due to the bile-salt-binding property of aluminium hydroxide, they advised caution "in the use of this agent (e.g. as an antacid) in colon cancer patients."
Lancet. 1978 Oct 7;2(8093):785. PMID: 80705
Long term results of gastrectomy with respect to blood lipids, blood pressure, weight and living habitsGlober GA, Rhoads GG, Liu F, Kagan A
A sample of ambulant Japanese-American men (ages 45-69 years), was divided into those having a previous partial gastrectomy and a control non-gastrectomy population. Three-hundred-and-forty-seven men with a history of partial gastrectomy weighed less and had lower values for serum cholesterol, triglyceride, and blood pressure than did the control population of 72598 men. The depressed lipid and blood pressure values could not be entirely explained by the reduced weight. Likewise, none of these differences appeared related to diet or living habits. Those operated on for gastric ulcer had, on the average, lower systolic pressures than duodenal ulcer patients and those with gastrojejunal anastamoses had lower cholesterol levels than patients with a gastroduodenostomy.
Annals of Surgery. 1974 Jun;179(6):896-901. PMID: 4835509
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