Hongo Michio, Nagasaki Yutaka, Shoji Tomotaka
Department of Comprehensive Medicine, Tohoku University Hospital, Aoba, Sendai, Japan.
J Gastroenterol Hepatol. 2009 May;24(5):729-35. doi: 10.1111/j.1440-1746.2009.05824.x.
Esophageal adenocarcinoma (EAC) has been rapidly increasing in Western countries during the past half century, especially in white men. Esophageal squamous cell carcinoma (ESCC) used to be the dominant type of esophageal malignancy both in Western and Asian countries. The rapid increase of EAC in Western countries has occurred in parallel with an increased prevalence of gastroesophageal reflux disease (GERD) and its major determinant, obesity. Such an increase in EAC has not yet been observed in Asia, despite a recent increase in prevalence of GERD. In this mini-review, we analyze possible factors influencing such east-west ('Orient to Occident') differences, particularly possible roles of ethnicity and environmental factors, such as Helicobacter pylori infection and nutritional factors, and how these might interact with socioeconomic differences. Development of Barrett's esophagus and esophageal adenocarcinoma appears to be strongly affected by ethnic factors, with populations resident at the west end of the Eurasian continent, such as Anglo-Celtics, being more prone to both conditions. On the other hand, ethnic groups from the eastern and southern ends of Eurasia, such as Chinese, Koreans and Japanese, and Africans might be more prone to developing esophageal squamous cell carcinoma. Future trends will also be discussed.
在过去半个世纪中，食管腺癌（EAC）在西方国家迅速增加，尤其是在白人男性中。食管鳞状细胞癌（ESCC）过去在西方国家和亚洲国家都是食管恶性肿瘤的主要类型。西方国家EAC的迅速增加与胃食管反流病（GERD）及其主要决定因素肥胖症患病率的上升同时发生。尽管最近GERD患病率有所上升，但在亚洲尚未观察到EAC的这种增加。在本综述中，我们分析了影响这种东西方（“从东方到西方”）差异的可能因素，特别是种族和环境因素（如幽门螺杆菌感染和营养因素）的可能作用，以及这些因素如何与社会经济差异相互作用。巴雷特食管和食管腺癌的发生似乎受到种族因素的强烈影响，居住在欧亚大陆西端的人群，如盎格鲁凯尔特人，更容易患这两种疾病。另一方面，来自欧亚大陆东端和南端的种族群体，如中国人、韩国人和日本人以及非洲人，可能更容易患食管鳞状细胞癌。还将讨论未来的趋势。
