Janet Ogundepo
Medical experts have warned that a high intake of salt may damage the gastric mucosa, the innermost lining of the stomach wall, leading to inflammation and an increased risk of gastric cancer.
The gastroenterologists, who specialise in diagnosing and treating diseases affecting the digestive system, also noted that excessive salt consumption can aggravate the activity of Helicobacter pylori, a bacterium that can cause stomach infections and is a common cause of peptic ulcers.
The National Cancer Institute defines gastric cancer, also known as stomach cancer, as a malignant tumour that begins in the cells lining the stomach
According to the International Agency for Research on Cancer, there were about 1.1 million cases and 770,000 deaths due to stomach cancer globally in 2020.
Medscape, a medical blog, reports that gastric cancer is the sixth most common cancer and the fourth leading cause of cancer-related deaths worldwide.
Although data on the burden of gastric cancer in Nigeria is limited, independent studies and experts report a rise in cases.
In separate interviews with PUNCH Healthwise, the gastroenterologists identified several risk factors for gastric cancer including, high salt diets, tobacco smoking, Helicobacter pylori, obesity, radiation, familial history of stomach cancer, previous gastric surgery and excessive alcohol consumption.
A recent study carried out in the United Kingdom and published in a journal, Gastric Cancer, reports that people who add salt to their food at the table increased their risk of developing stomach cancer by 41 per cent.
The study further raised concerns about the rising prevalence of stomach cancer among young people worldwide.
“Salt can damage the stomach mucosa, increasing its vulnerability to Helicobacter pylori colonisation and raising the risk of gastric cancer through mechanisms other than infection, such as harming gastric epithelial cells with chemical carcinogens and N-nitroso molecules,” the study noted.
PUNCH Healthwise recently reported the rising cases of cancers, particularly colorectal cancer, among children and young adults.
The report highlighted how colorectal cancer, which mostly affects people aged 50 and above, is now occurring in children and young adults between the ages of 10 and 19.
Speaking on the issue, a Consultant Gastroenterologist at the University of Ilorin Teaching Hospital, Kwara State, Dr Matthew Bojuwoye, said that although reliable national data on the burden of gastric cancer in Nigeria is lacking, it accounts for about 1.1–6.0 per cent of all cancers.
He added that the incidence rate was higher in the Southern than the Northern parts of the country.
The specialist noted that a high intake of salted foods may damage the stomach lining and increase the risk of gastric cancer.
Aside from the increased risk of gastric cancer, Bojuwoye further stated that high salt intake increases the presence of Helicobacter pylori, leading to an exacerbation of ulcer symptoms
He said, “High dietary salt intake also results in increased H. pylori colonisation in gastric mucosa. The increased virulent strains of H. pylori lead to gastritis and ulceration; changes in the structure and function of epithelial cells; high levels of oxidative stress and the production of free radicals and DNA damage. All of these molecular mechanisms increase the risk of developing cancer.
“High salt intake can exacerbate ulcer symptoms given that it can cause inflammation of the gastric mucosa and encourage the growth of H. pylori, further worsening the inflammation. This will result in delayed healing of the ulcer.”
The gastroenterologist also stated that benign gastric ulcers not properly managed could progress to gastric cancer.
He explains, “Gastric cancer may present in the form of an exophytic mass, an ulcer or an ulcerating mass. While benign gastric ulcers themselves are not cancerous, they can sometimes progress to gastric cancer, particularly if certain risk factors are present or if they are not appropriately managed.
“Gastric ulcers often result from chronic inflammation of the stomach lining, which can be caused by factors such as infection with H. pylori, long-term use of non-steroidal anti-inflammatory drugs, excessive alcohol consumption, or smoking. Chronic inflammation can lead to changes in the cells of the stomach lining, increasing the risk of cancer development over time.
“If a gastric ulcer becomes complicated, such as by bleeding or perforation, the healing process may involve the regeneration of abnormal tissue. This abnormal tissue, if left untreated or if predisposing factors persist, can potentially progress to cancerous cells,” Bojuwoye said.
He further noted that the presence of precancerous lesions in the surrounding stomach tissue increased the likelihood of gastric cancer development if not appropriately managed or monitored.
The doctor called for early diagnosis and effective treatment of gastric ulcers to prevent the risk of cancer development.
He said, “While the majority of gastric ulcers do not progress to cancer, it is essential to monitor and manage them effectively, especially in individuals with risk factors for gastric cancer.
“This may involve treating underlying causes such as H. pylori infection, reducing risk factors like smoking and alcohol consumption, and regular surveillance through endoscopy and biopsy to detect any precancerous changes or early signs of cancer. Early detection and appropriate treatment of gastric ulcers and associated risk factors can help prevent progression to malignancy.”
The consultant gastroenterologist discouraged the use of salt in food preservation and urged individuals with ulcers, especially those with a familial history of gastric cancer to undergo regular screening to facilitate early diagnosis and treatment.
He also called for investment in research and development to improve diagnostic techniques and aid in early detection and treatment of stomach cancer.
Bojuwoye noted that underreporting of cases due to inadequate diagnostic facilities, lack of trained personnel and poor health-seeking behaviour remained a major challenge in the early diagnosis and treatment of gastric cancer.
A Professor of Gastrointestinal Physiology at the University of Calabar, Cross River State, Agona Obembe, stated that ulcers not well managed could lead to stomach cancer.
She confirmed that high salt intake increased the activities of the H. pylori bacteria, making the ulcers difficult to eliminate and predisposing the patients to gastric cancer.
The don said, “Ulcers that are not well managed can become cancerous. Also, salt enables Helicobacter pylori bacteria to thrive and it is a major cause of ulcers. It is also very difficult to treat and eliminate because of the place it stays in the stomach. Ulcers cause wounds all over the stomach and when it is not healing, the wound can become cancerous.
“Salt has always been a culprit in stomach ulcers. Cultures have been studied and it shows that it increases the activities of H.pylori, which is a major culprit in ulceration and when not well treated, it can become cancerous. It can cause bleeding into the stomach.”
Obembe further noted that due to the focus on ulcer treatment, gastric cancer is usually detected late.
The gastroenterologists called for a reduction in salt addition and preservation of foods and advised against the use of table salt shakers.
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