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Although the recent rise in oesophagus adenocarcinoma has been linked to the increasing incidence of reflux, the active ingredient of the refluxate is unclear. The current study focuses on the possible role of dietary nitrate, which is excreted in saliva, metabolised in the mouth to nitrite, and, on contact with gastric acid, converted to nitrous acid and reactive nitrozating species which produce potential carcinogenic N-nitrozo compounds. Studies in normal subjects without reflux have demonstrated that the lowest vitamin C to nitrite ratio, which predisposes to the generation of N-nitroso compounds, occurs in the gastric cardia. The current study of patients with Barrett’s oesophagus with reflux shows that the site where this ratio is lowest has migrated proximally and lies in the squamous oesophagus and the Barrett’s segment. By directly studying the generation of nitric oxide they were also able to show in three patients that reflux of acid into a
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