1355 gastrectomy for duodenal ulcer support an xtiological as . sociation between increased nitrite in the hypochlorhydnc stu-
tial
Letters
to
the Editor
’mach and the development of carcinoma
GASTRIC-JUICE NITRITE AND GASTRIC CANCER SIR,-Interest in the subject of gastric-juice
nitrite concen-
tration and the
aetiology of carcinoma of the stomach’-3 has prompted us to investigate the nitrite levels in the fasting gastric juice of patients undergoing endoscopic review 15-27 years after partial gastrectomy for benign ulcer disease. Such patients are at increased risk of carcinoma in the gastric stump,4.5 and in 63 patients we have confirmed a high incidence of premalignant change (intestinal metaplasia with atrophic gastritis in 29 cases) and found marked dysplasia in 3 cases.
m
the
University Department of Surgery, Bristol Royal Infirmary,
stump.
S. M. JONES P. W. DAVIES
Bristol BS2 8HW
Southmead
gastric
Hospital,
A. SAVAGE
Westbury-on-Trym
MORTALITY RATIOS FOR MEN IN SCOTLAND AND SWEDEN
SiR,—Dr Logan and his colleagues (May 6, p. 949) showed that, in random samples of men all aged 40 surveyed in Edinburgh and Stockholm, the Edinburgh men smoked more
Gastric-juice nitrite concentrations were reported by Ruddell al. to be increased in patients with carcinoma of the stomach heavily than the Stockholm men and had higher blood(mean level 38.8 tmol/1) and they also showed an inverse rela-2 u - pressures, lower exercise tolerance, excess weight, and raised tionship between H+ concentration and nitrite concentration. serum-triglycerides. These contrasts, Logan et al. postulated, Thus conditions suitable for the formation of carcinogenic would partly explain the great differences in male mortality nitrosamines exist in the hypochlorhydric stomach, and such from ischa:mic heart-disease (I.H.D.) between the two counan aetiological association could be an explanation for the intries. The differences in male mortality between Scotland and creased incidence of carcinoma after partial gastrectomy. If Sweden, however, are particularly interesting when examined this were so we would expect a correlation between increased at different ages and for other specific diseases associated with levels of nitrite and the metaplastic and dysplastic histological the adverse factors surveyed in the two cities. The figure shows the ratio of the adult male mortality-rates changes seen in our patients. This appears to be the case in those patients studied so far; among the 27 cases of partial gastrectomy for duodenal ulceration for which gastric juice analysis has been done (see figure) half the patients with these histological changes had increased gastric-juice nitrite concentrations and no patient without these changes had increased nitrite. 8 of 10 patients with significant dysplasia had et
nitrite levels above 10 fLmol/1 and all those without these histological changes had nitrite levels below 10 vmol/I lP
tial
Letters
to
the Editor
’mach and the development of carcinoma
GASTRIC-JUICE NITRITE AND GASTRIC CANCER SIR,-Interest in the subject of gastric-juice
nitrite concen-
tration and the
aetiology of carcinoma of the stomach’-3 has prompted us to investigate the nitrite levels in the fasting gastric juice of patients undergoing endoscopic review 15-27 years after partial gastrectomy for benign ulcer disease. Such patients are at increased risk of carcinoma in the gastric stump,4.5 and in 63 patients we have confirmed a high incidence of premalignant change (intestinal metaplasia with atrophic gastritis in 29 cases) and found marked dysplasia in 3 cases.
m
the
University Department of Surgery, Bristol Royal Infirmary,
stump.
S. M. JONES P. W. DAVIES
Bristol BS2 8HW
Southmead
gastric
Hospital,
A. SAVAGE
Westbury-on-Trym
MORTALITY RATIOS FOR MEN IN SCOTLAND AND SWEDEN
SiR,—Dr Logan and his colleagues (May 6, p. 949) showed that, in random samples of men all aged 40 surveyed in Edinburgh and Stockholm, the Edinburgh men smoked more
Gastric-juice nitrite concentrations were reported by Ruddell al. to be increased in patients with carcinoma of the stomach heavily than the Stockholm men and had higher blood(mean level 38.8 tmol/1) and they also showed an inverse rela-2 u - pressures, lower exercise tolerance, excess weight, and raised tionship between H+ concentration and nitrite concentration. serum-triglycerides. These contrasts, Logan et al. postulated, Thus conditions suitable for the formation of carcinogenic would partly explain the great differences in male mortality nitrosamines exist in the hypochlorhydric stomach, and such from ischa:mic heart-disease (I.H.D.) between the two counan aetiological association could be an explanation for the intries. The differences in male mortality between Scotland and creased incidence of carcinoma after partial gastrectomy. If Sweden, however, are particularly interesting when examined this were so we would expect a correlation between increased at different ages and for other specific diseases associated with levels of nitrite and the metaplastic and dysplastic histological the adverse factors surveyed in the two cities. The figure shows the ratio of the adult male mortality-rates changes seen in our patients. This appears to be the case in those patients studied so far; among the 27 cases of partial gastrectomy for duodenal ulceration for which gastric juice analysis has been done (see figure) half the patients with these histological changes had increased gastric-juice nitrite concentrations and no patient without these changes had increased nitrite. 8 of 10 patients with significant dysplasia had et
nitrite levels above 10 fLmol/1 and all those without these histological changes had nitrite levels below 10 vmol/I lP
