Gastric carcinoma promoted by alkaline reflux gastritis -- with special reference to bile and other surfactants as promoters of postoperative gastric cancer.

For reasons that are not known, the incidence of stomach cancer is declining in most countries. In contrast, cancer of the gastric remnant after partial gastrectomy for peptic ulcer disease seems to be increasing. "Stump cancer" has been claimed to be a separate disease entity and has recently been mentioned as an iatrogenic cancer. Alkaline bile reflux, dietary surfactants and maybe the abuse of tobacco are postulated as promoting or initiating agents, in causing malignant transformation of the operated as well as non-operated stomach. Variations in gastric pH, microflora and emptying rate may be of importance in the carcinogenic process. The decline in cancer incidence in the non-operated stomach has mainly been restricted to the intestinal type of cancer. Thus, it is important to note that stump cancer often is of the diffuse type. Different target cells and/or modes of carcinogen exposure may be of etiological importance in these histologically and clinically separate neoplastic diseases.