Diseases of the Stomach and Duodenum胃十二指肠外科疾病.ppt

Gastric cancer may often be multifactorial, involving both inherited predisposition and environmental factors. Environmental factors implicated in the development of gastric cancer include diet, Helicobacter pylori infection, previous gastric surgery, pernicious anemia, adenomatous polyps, chronic atrophic gastritis, and radiation exposure. Diet A diet rich in pickled vegetables, salted fish, salt, and smoked meats correlates with an increased incidence of gastric cancer.6 A diet that includes fruits and vegetables rich in vitamin C may have a protective effect.7 Smoking Smoking is associated with an increased incidence of stomach cancer in a dose-dependent manner, both for number of cigarettes and for duration of smoking. Smoking increases the risk of cardiac and noncardiac forms of stomach cancer.8Cessation of smoking reduces the risk. A meta-analysis of 40 studies estimated that the risk was increased by approximately 1.5- to 1.6-fold and was higher in men.9 Helicobacter pylori infection Chronic bacterial infection with H pylori is the strongest risk factor for stomach cancer. H pylorimay infect 50% of the worlds population, but many fewer than 5% of infected individuals develop cancer. It may be that only a particular strain of H pylori is strongly associated with malignancy, probably because it is capable of producing the greatest amount of inflammation. In addition, full malignant transformation of affected parts of the stomach may require that the human host have a particular genotype of interleukin (IL) to cause the increased inflammation and an increased suppression of gastric acid secretion. For example, IL-17A and IL-17F are inflammatory cytokines that play a critical role in inflammation. Wu et al found that carriage of IL-17F 7488GA and GG genotypes were associated with an increased risk of gastric cancer.10 H pyloriinfection is associated with chronic atrophic gastritis, and patients with a history of prolonged gastritis have a sixfold increased