A reinterpretation of the events in gastric carcinogenesis.

It is proposed here that the initial events in gastric carcinogenesis occur at the junction of the oxyntic and antral mucosae. Intestinal metaplasia represents an adaptive counter-response to early neoplastic change at this site. Chronic gastric ulceration may arise due to the elimination of overtly dedifferentiated cells at a later stage in the evolution of the neoplastic process. Intestinal type gastric carcinoma possibly represents breakthrough past these mechanisms.