Cellular Phenotypic Changes With Long-Term Acid and Bile Exposure to a Barrett's Epithelial Cell Line

Abstract

Background & Aims: In Aisa, esophageal diseases, such as Barrett's esophagus (BE) and adenocarcinoma of the esophagogastric junction (EGJ), have traditionally been less common than in America and Europe. Although the number of reported cases of these conditions in Japan has gradually increased in recent years, little is known about the epidemiology of these diseases and relationship between them. The aim of this study was to investigate the clinicoepidemiological characteristics of these two diseases in Japan. Methods: The study reviewed a total of 88,199 cases of upper gastrointestinal endoscopies and associated medical records at 13 centers in Kurashiki, Japan between January 2008 and June 2010 (48,548 men, 39,651 women; mean age 62 years). The diagnosis of BE was defined as an endoscopically identifiable columnar-lined esophagus of more than 3 cm in length. Adenocarcinomas of the EGJ were classified into 3 types according to Siewert's classification. Results: Among the 88,199 patients, there were 13 patients with BE (0.014%): they were all men with a mean age of 64 years, 53.8% had a hiatal hernia and 84.6% had no gastric mucosal atrophy. Out of all the subjects, there were 56 patients with an adenocarcinoma of the EGJ (0.063%): one patient had an adenocarcinoma of the distal esophagus (Type I); 44 patients had true carcinomas of the cardia (Type II); and 11 patients had subcardial carcinomas (Type III). Obvious differences were found in the clinical characteristics between Type I+II carcinomas (n=45) and Type III carcinomas (n=11) (Table 1). Conclusions: The incidence of BE and adenocarcinoma of the EGJ are still lower in Japan than in Western countries. The clinical characteristics are different between Type I+II and Type III. The clinical characteristics of patients with BE are similar to those of patients with adenocarcinoma of the EGJ (Type I+II). Table 1. Clinical characteristics of patients with adenocarcinoma of the EGJ