Oesophageal cancer in gastric surgery patients

Oesophageal adenocarcinoma (which has been steadily increasing in incidence during the last 20 years) is thought to be promoted by gastric reflux. In a cohort of 5018 gastric surgery patients, 19 of whom developed oesophageal cancer, there was no increased proportion of adenocarcinomas. We conclude that the hypothesized aetiology was not supported.

Soil moisture and temperature affect condensed tannin concentrations and growth in Lotus corniculatus and Lotus pedunculatus

Maku big trefoil and Dewey birdsfoot trefoil were grown at 14/10, 20/16, 26/22 and 32/28�C (14/10 h) in growth cabinets. Growth rates and condensed tannin (CT) concentrations were measured as soil moisture was changed from field capacity (FC) to 20% FC to FC again in three regrowth cycles. Seasonal dry matter accumulation and CT concentrations were also measured on these cultivars together with Sharnee big trefoil, Monarch cicer milkvetch, Chemung crownvetch and WL605 lucerne at two sites in the field. Condensed tannin concentrations were not greatly affected by temperature alone. However, moisture stress induced proportionately larger reductions in growth rates of big trefoil as temperature increased, and correspondingly larger rises in CT concentrations. Condensed tannin concentrations in birdsfoot trefoil were largely unaffected by these factors. In big trefoil, the responses in CT levels and growth rates continued even when soil moisture was returned to FC. Low temperature did not appear to affect CT concentrations in big trefoil, but caused some slight elevation in concentrations in birdsfoot trefoil. In the field, CT levels in the big trefoil cultivars, and in birdsfoot trefoil, were elevated in summer and autumn, when temperatures were high and periods of soil moisture stress occurred. The potential for elevated CT levels in big trefoil appears to be enhanced when growth rates are reduced by moisture stress and temperaturs are high. Big trefoil should be carefully screened for CT concentrations in the process of cultivar development. High CT levels are not a problem in birdsfoot trefoils such as Dewey.

Malignancy following surgery for benign peptic disease: a review

Since 1986 there have been a number of large studies of cancer risk after surgery for benign disease involving over 20,000 patients followed for at least 20 years. All show that gastric surgery carries an excess risk of gastric cancer after a 15-20 year latency. There is less agreement about the excess risk at other sites. The size of such risks appears to depend on the size of cohort, type of ulcer, type of surgery, length of follow-up and level of analytical detail. Statistically significant excess risks have been reported for cancer of the colon (6/8 studies), biliary tract (4/5), lung (6/6), bladder (3/3), pancreas (4/7) and all sites (2/3). Our own study showed an excess risk of cancer of the gallbladder (14.3 fold), stomach (4.5), breast (4.0), bronchus (3.9), large bowel (1.6), oesophagus (2.3), pancreas (4.0), bladder (2.4) and all sites (3.3).

Supplementation of an adapted formula with bovine lactoferrin: 1. Effect on the infant faecal flora

The development of the infant faecal flora was studied over the first three months of life in infants receiving breast milk, a modern adapted formula and adaptations of this formula. Breast-fed infants developed a flora rich in Bifidobacterium sp. Facultative anaerobes were ubiquitous, but in relatively small numbers within the diet group. Other obligate anaerobes, such as Clostridium sp. and Bacteriodes sp. were rarely isolated. Standard formula produced a flora rich in bifidobacteria, but the growth of facultative organisms was not suppressed by this diet. Clostridium sp. and Bacteroides sp. were more common in this feeding group. After the addition of lactoferrin at 10 mg/100 ml to the formula diet, a flora similar to that of the standard formula-fed babies was achieved. Lactoferrin at 100 mg/100 ml was able to establish a "bifidus flora" in half of the babies given this formula, but only at age three months. Clostridium sp. and Bacteroides sp. were common faecal isolates from babies receiving both the lactoferrin diets.

The rectal mucosa-associated microflora in patients with ulcerative colitis

The rectal mucosa-associated flora (MAF) of patients with ulcerative colitis has been studied in 25 patients with newly diagnosed disease, 20 with relapse of existing disease, and 44 who were in remission. Patients with active disease were re-examined twice during treatment. The MAF was simpler and less dense than the microflora of faeces. Obligate anaerobes usually predominated in the MAF although the ratio of obligate anaerobes to facultative species was lower than that found in faeces. Viable counts of the total flora and of its constituent genera varied considerably between patients. Counts of the total flora, of obligate anaerobes (including bifidobacteria, eubacteria and clostridia), and facultative organisms and micro-aerobes (enterobacteria and lactobacilli) were reduced in patients with active disease compared with those with inactive disease; corresponding carriage rates were also lower. Counts and carriage rates increased during treatment and approached those found in quiescent disease. The alterations in the MAF were especially marked in patients experiencing their first attack of ulcerative colitis. The relationship between these alterations and the aetiology and pathogenesis of this disease remains unclear.

Search for enteric microbial pathogens in patients with ulcerative colitis

Microbial pathogens were sought in faeces of patients with active ulcerative colitis and again after 3 months treatment. 64 patients were examined during their first episode of ulcerative colitis and 30 with relapse of chronic disease. At presentation, bacterial pathogens were not found; 1 patient had cryptosporidiosis. In 10 patients treatment appeared to result in some loss of colonisation resistance as evidenced by colonisation with beta-haemolytic streptococci, Staphylococcus aureus, candida and Clostridium difficile. Unidentified cytotoxic activity was present in the faeces of 4 patients at presentation and 2 patients during or after treatment. We conclude that enteric infection is an uncommon finding in patients with active ulcerative colitis.

Biliary bile acid profiles in familial adenomatous polyposis

Patients with familial adenomatous polyposis have an excess risk for adenomas and cancers of the upper and lower gastrointestinal tract. In the upper intestine these lesions occur mainly around the ampulla of Vater and they parallel mucosal exposure to bile. In view of this finding and of evidence that bile acids play a role in colorectal carcinogenesis, biliary bile acid profiles were determined in 29 patients with familial adenomatous polyposis (12 before colectomy, 17 after colectomy) and in 28 patients without familial adenomatous polyposis (all with colons in situ). Patients with familial adenomatous polyposis had a higher total biliary bile acid concentration than the others. The bile of patients with polyposis had a greater proportion of chenodeoxycholic acid and a lower proportion of deoxycholic acid than did the bile of patients without polyposis. The ratio of chenodeoxycholic acid and its metabolite lithocholic acid to cholic acid and its metabolite deoxycholic acid, which is related to subsequent bile acid profiles in the colon, was higher in patients with polyposis. Because bile acids influence cellular proliferation, these findings may be of importance with respect to intestinal adenoma and cancer growth.

Sward growth of monocultures and binary mixtures of phalaris, lucerne, white clover and subterranean clover under two defoliation regimes

Sirosa phalaris, WL5 15 lucerne, Haifa white clover and Seaton Park subterranean clover were grown in monocultures and binary mixtures on a cracking clay soil and cut at 4- and 8-week intervals over 3 growing seasons at Scone, New South Wales (32�S.). The plots were given supplementary irrigation between mid April and November to prevent water deficits. The deep-rooted perennials dominated mixtures under infrequent cutting, with cumulative dry matter yields for the growing season reaching 11 t/ha for lucerne-based mixtures. Frequent defoliation increased the contribution of the clovers in mixtures, and mixtures and monocultures containing clovers were more productive than other plots in winter, 1986. Frequent defoliation reduced the vigour and density of lucerne, resulting in balanced mixtures with phalaris and subterranean clover in the third year. Only lucerne plots contributed large amounts of dry matter yield (up to 4 t/ha) between December and April. Regeneration of subterranean clover from seedlings, and white clover from seedlings or stolons, was better in clover-only plots than in mixtures with phalaris. The growth of mixtures in response to mean daily air temperature in spring could be divided into 2 distinct patterns, with growth peaking at about 15�C for determinate (annual or dormant) mixtures, and at about 18�C for lucerne mixtures and pure white clover. In autumn, growth patterns were determined by the method of regeneration (i.e. by seedings or dormant crowns).

Competition between Clare and Seaton Park, and Clare and Daliak subterranean clovers in replacement series mixtures in the field

Binary mixtures of Clare and Seaton Park, and Clare and Daliak subterranean clovers were grown for three years in de Wit replacement series in the field and defoliated at approximately 4-week intervals between mid-winter and the end of October. For the most part both mixtures exhibited competition for the same resources with Clare dominant, and progressively excluding the other cultivars; this exclusion was more rapid with Daliak than with Seaton Park. Seed production of both Seaton Park and Daliak was depressed in mixtures, and seed reserves were reduced to virtually zero by the third year, although significant growth and seed reserves remained in the monocultures. Seed production from Clare was much less dependent on plant population than was seed production from Seaton Park and Daliak. Variation between replicates and spatial heterogeneity of sward composition was greater in the Daliak experiment on a heavy clay than in the Seaton Park experiment on a lighter soil. In both experiments, large quantities of seed could not be accounted for in germinations and residual seed reserves-80% in 1986 and 33% in 1987. Significant seed losses may be characteristic of the ecology of subterranean clover in summer rainfall zones. The success of Clare in northern New South Wales may be due mainly to the vigour and high seed production capacity of individual plants.

Bacterial N-nitrosation and gastric carcinogenesis in humans

It has been hypothesized that bacterially produced N-nitroso compounds cause the progression from chronic atrophic gastritis through intestinal metaplasia and dysplasia to gastric cancer. If this is true then various consequences follow. These consequences are discussed, together with the evidence for or against them. The conclusion is that there is much to support the hypothesis.

The effect of gastric achlorhydria on the urinary recovery of nitrate in man: relevance to urinary nitrate as a measure of dietary nitrate exposure

It is important to have a reliable method of assessing the dietary nitrate exposure of populations for a proper understanding of the potential health effects of the endogenous metabolites of this ion to be gained from epidemiological studies. Recently we strongly advocated the use of the nitrate analysis of 24 h urine samples as being a superior method for such studies. Our previous observations and those of others relating to nitrate pharmacology in healthy human volunteers formed the basis of this judgement. The purpose of this study was to determine whether gastric achlorhydria or hypochlorhydria has any significant gross effects on the urinary recovery of dietary nitrate and to what extent the inclusion of such individuals would compromise the results of potential epidemiological studies. The results demonstrated a significantly greater loss of dietary nitrate as measured by urinary recovery in achlorhydrics than in normochlorhydrics, presumably as a consequence of bacterial metabolism in the colonized stomach. Thus the average urinary nitrate recovery of a 1.5 mmol challenge was 33% in individuals with reduced stomach acidity as compared to 56% in normal controls. This significant further loss of nitrate (average 23%) when intragastric conditions favour bacterial colonization clearly indicates that for valid assessments and comparisons of nitrate exposure between populations it would be wise to exclude individuals with low levels of stomach acid where this is likely to lead to significant gastric colonization by nitrate-reducing bacteria (i.e. pH less than 4-5).

Experimental colonic carcinogenesis after gastric surgery

Peptic ulcer surgery may predispose to the subsequent development of colorectal cancer. This experimental study has investigated the effects of gastric operations on colonic cell proliferation, bile acid excretion and carcinogenesis. Male Sprague-Dawley rats (n = 105) underwent sham operation, Pólya partial gastrectomy or vagotomy and pyloroplasty. The carcinogen azoxymethane was administered weekly for 6 weeks thereafter (total dose 60 mg kg-1). When the animals were killed 24 weeks after operation, colons were examined for mucosal mass, crypt cell production rate (CCPR) and tumour yield; faeces were assayed for contents of neutral steroids and bile acids (both total and individual). Morphometric indices and mucosal DNA content were similar in all three groups. Pólya gastrectomy reduced: (1) CCPR throughout the colon (by 42-65 per cent, P less than 0.002); (2) the number of rats with colorectal tumours (26 per cent versus 63 per cent, P less than 0.05); (3) faecal levels of neutral steroids and bile acids, notably hyodeoxycholic acid (P less than 0.01). Although vagotomy and pyloroplasty increased caecal CCPR, there were no consistent differences in faecal steroids and no alteration in tumour yield after the operation. These results fail to support clinical studies suggesting that gastric surgery predisposes to colonic carcinogenesis. Indeed, Pólya partial gastrectomy exerts a protective effect, probably by inhibiting colonic cell proliferation.

Dietary modification of potential vitamin K supply from enteric bacterial menaquinones in rats

Rats given a low-fibre diet based on boiled white rice developed symptoms of severe vitamin K deficiency within 23 d. Inclusion of autoclaved black-eye beans (Vigna unguiculata) in the diet prevented the bleeding syndrome. To test the hypothesis that deficiency resulted from low phylloquinone intake exacerbated by inadequate production of menaquinones by the enteric bacteria, a follow-up experiment was carried out in which groups of rats were given an all-rice diet, a rice + beans diet or a stock diet. Rats on the all-rice diet had significantly lower faecal concentrations of the main menaquinone-producing bacterial species (Bacteroides fragilis and Bacteroides vulgatus) than animals on either of the other two diets. This coupled with the much lower faecal output on this diet suggests that total menaquinone production was low for the all-rice diet. The alterations in faecal flora were associated with several significant changes in caecal metabolism. Rats given the stock diet had much shorter caecal transit times and a considerably greater proportion of butyric acid in volatile fatty acid end-products than did rats on either of the other two diets.

Occupational and socioeconomic factors associated with peptic ulcer and with cancers following consequent gastric surgery

Over 3000 patients, treated surgically for peptic ulcers, were assigned to a Social Class and Occupation Group using information obtained either from their death certificates or from their hospital notes. An analysis of the relationship of socioeconomic status and occupation with the site of original ulcer and the risk of cancer is reported. The major observations were: (a) an association of gastric ulcer with manual and of duodenal ulcer with non-manual Social Class; (b) an association of gastric cancer with dusty occupation and colorectal cancer with professional and managerial workers; and (c) no association between post-surgery gastric cancer risk and social class. This implies that the early stages of gastric carcinogenesis are related to poor socioeconomic conditions but the progression from the precursor lesion (in this case gastric ulcer) to gastric cancer is not, and is consistent with the multistage hypothesis of gastric carcinogenesis proposed by Correa [Diet and Human Carcinogenesis (Edited by Joosens, J. V., Hill, M. J. and Geboers, J.), pp. 109-115. Excerpta Medica, Amsterdam (1985)].

Primary prevention of colorectal cancer. The WHO Collaborating Centre for the Prevention of Colorectal Cancer

Colorectal cancer is the third most common malignant neoplasm worldwide. Epidemiological and laboratory animal studies have established a link between various nutritional factors and the etiology of this cancer. Recent studies in genetic epidemiology and molecular biology have shown that inherited genetic factors also play an important role in colorectal carcinogenesis. Thus, genetic-nutritional interactions may form the basis for the development of this cancer. Nutritional factors that appear to promote or attenuate the carcinogenic process in the colon include fat, excess calories, fibre, calcium, selenium, and various vitamins. Strategies for primary prevention of colorectal cancer should therefore be targeted to all populations who are at risk because of dietary and hereditary predisposition. Based on current knowledge, recommended nutrition guidelines for reducing the risk of colon cancer include decreased fat consumption, adequate amounts of fruits, vegetables, and calcium, and avoidance of overweight. Research to further elucidate the role of diet in colorectal carcinogenesis should include randomized studies in humans, testing of various nutritional regimens, and the use of colonic adenomas and markers of cell proliferation and differentiation as end-points.

Improving the tolerance of Phalaris aquatica L. to soil acidity by introgression of genes from P. arundinacea L

A comparison was made of the growth on acid and non-acid soils near Canberra of 66 lines in Phalaris aquatica, in seven other Phalaris species which can be crossed with P. aquatica and in seven allopolyploid or backcross hybrids involving P. aquatica. The yield of tops by mid-spring on the strongly acid site was only 20% of that on the mildly acid site. Some variation was apparent among the 38 P. aquatica accessions and cultivars, but some P. arundinacea accessions and hybrids were less inhibited by acidity than any P. aquatica line. Fifty plants from the first or second backcross of four P. aquatica X P. arundinacea hybrids to P. aquatica were selected for their capability of producing a large root system in a nutrient solution containing 10 mg aluminium per L at pH 4.1. On acid soils near Bendigo, Seymour, Benalla and Canberra, offsets of seven of these backcross plants were rated as growing significantly larger at the end of the first growing season than plants of Sirosa, Sirolan and Uneta phalaris, Porto and Currie cocksfoot, Demeter and Melik tall fescue and of Victorian and Brumby perennial ryegrass. However, two of the backcross genotypes appeared to be significantly smaller than the phalaris and cocksfoot controls. Thus, factors in addition to excess aluminium appear to affect the growth of phalaris in these soils, but some backcross genotypes tolerate these adverse conditions. Four of the productive, acid-tolerant genotypes survived the first summer, regenerated vigorously in the following autumn, were palatable to sheep in test grazings over two summers at Armidale, N.S.W., and also were fertile and retained some of the ripe seed in their panicles. Therefore, it seems probable that phalaris cultivars for acid soils in south-eastern Australia can be selected from later generations of the backcross population.

The effect of different sources of nitrate exposure on urinary nitrate recovery in humans and its relevance to the methods of estimating nitrate exposure in epidemiological studies

It was demonstrated that nitrate concentration fluctuates dramatically in both urine and saliva throughout the study period and hence single time point ('spot') samples of either fluid give a poor measure of previous nitrate exposure. In contrast, the nitrate recovery in complete 24 h urine collections showed a strong positive correlation with previous nitrate exposure which was independent of the nature of the food matrix in which the nitrate was ingested. Regression analysis of the data showed that the apparent urinary recovery of 70% appears to consist of 55% arising from the original challenge and a background of approximately 0.22 mmol/day which is independent of the challenge and which may reflect endogenous mammalian synthesis of nitrate. It is therefore important that in future epidemiological studies, in which dietary nitrate exposures are to be determined, that analyses are conducted only on 24 h urine collections. A large inter-individual variation was found in the conversion of salivary nitrate to nitrite presumably mediated by the oral flora. The resulting differences in nitrite formation may be one of the factors determining the level of endogenous N-nitroso compound formation in an individual.

Use of a modified N-nitrosoproline test to show intragastric nitrosation in patients at risk of gastric cancer

Intragastric nitrosation has been implicated in the pathogenesis of gastric cancer and in precancerous conditions such as pernicious anaemia and the post-gastrectomy state. Intragastric nitrosation was assessed in at-risk patients by N-nitrosoproline (NPRO) excretion using both a conventional and a modified test. Twenty-four hour urinary excretion of NPRO was measured after oral administration of sodium nitrate (300 mg) and L-proline (500 mg) as an indirect indicator of intragastric nitrosation. In the conventional test no differences in intragastric nitrosation were found between at-risk patients and controls. In the modified test the loading dose of sodium nitrate was omitted and urinary NPRO levels were found to be significantly increased in Polya partial gastrectomy patients (P = 0.003) and post-vagotomy patients (P = 0.03) compared to controls. In pernicious anaemia patients NPRO levels were also higher than in controls but just failed to reach statistical significance. This study has confirmed that hypochlorhydria results in increased intragastric nitrosation, thus facilitating the formation of potentially carcinogenic N-nitroso compounds.