There are conflicting reports on whether nitrate intake is related to gastric carcinogenesis. In this laboratory/field study from a high-risk area for gastric cancer, we analysed 178 samples of drinking water for nitrate and nitrite, and examined the relationship between gastric mucosal lesions (including gastric cancer) and quality of different types of drinking water and nitrate intake via water. The results showed that the nitrate content in the local drinking water was generally very high, with a mean of 109.6 mg/l (range 4.4-497.2 mg/l). There were significant differences in the nitrate content in drinking water from different wells in qualitatively different types of water. The histological changes were closely related to the quality of drinking water and its nitrate content. The results suggest that nitrate in drinking water probably plays an important role in gastric carcinogenesis and that in future aetiological studies of gastric cancer should include more information on well depth, the presence of public or private wells and nitrate content of water.