Division of Surgery, Tokai University Oiso Hospital, Oiso, Japan,
Division of Gastroenterological Surgery, Tokai University, Oiso, Japan.
Digestion. 2019;99(2):185-190. doi: 10.1159/000490508. Epub 2018 Nov 27.
The incidence of esophageal adenocarcinoma in Europe and the United States rapidly increased from the latter half of the 1970s and exceeded that of esophageal squamous cell carcinoma in the latter half of the 1990s, currently accounting for approximately 60% of all esophageal carcinomas. Recently, its incidence has also increased in Japan, raising concerns that it will follow a course similar to that in Europe and the United States.
The incidence of esophageal adenocarcinoma in Japan was about 2% until the 1990s, but in recent years, it has risen to 6.5-7.1%. Causes include the increase in the incidence of obesity due to changes in eating habits with resultant increases in the incidence of hiatal hernia and reflux esophagitis, a decrease in the rate of Helicobacter pylori infection, and the increased interest of physicians in the gastroesophageal junction. The number of gastroesophageal reflux disease patients in Japan rapidly increased from the 1990s, which accordingly increased the number of Barrett's esophageal adenocarcinoma patients from the latter half of the 1990s. Tabulation and analysis of 1,794 reported cases of Barrett's esophageal adenocarcinoma in Japan showed that superficial cancers accounted for 77.6%, and that the concomitant rates of hiatal hernia and reflux esophagitis were high at 87 and 70% respectively. Key Message: The future trend in the incidence of Barrett's esophageal adenocarcinoma in Japan will depend on the increase in the incidence of reflux esophagitis, which is essential for the development of Barrett's esophagus and Barrett's esophageal carcinoma. The obesity rate is lower in Japan than that in Europe and the United States, and the incidence and severity of reflux esophagitis are low. We expect that the incidence of Barrett's esophageal adenocarcinoma in Japan will not rise as high as in Europe and the United States, and will remain below 10%.
欧美地区的食管腺癌发病率自 20 世纪 70 年代后半叶开始迅速上升，并于 20 世纪 90 年代后半叶超过食管鳞癌，目前约占所有食管癌的 60%。近年来，日本的发病率也有所增加，人们担心其发展趋势将与欧美相似。
日本的食管腺癌发病率在 20 世纪 90 年代前约为 2%，但近年来已上升至 6.5-7.1%。原因包括饮食习惯改变导致肥胖发病率上升，由此引起的食管裂孔疝和反流性食管炎发病率上升，幽门螺杆菌感染率下降，以及医生对胃食管交界处的关注度提高。日本胃食管反流病患者数量从 20 世纪 90 年代开始迅速增加，由此 Barrett 食管腺癌患者数量也从 20 世纪 90 年代后半叶开始增加。对日本 1794 例 Barrett 食管腺癌报告病例进行列表和分析显示，表浅型癌症占 77.6%，同时食管裂孔疝和反流性食管炎的合并率分别高达 87%和 70%。
日本 Barrett 食管腺癌的未来发病趋势将取决于反流性食管炎发病率的增加，这是 Barrett 食管和 Barrett 食管腺癌发展的关键。日本的肥胖率低于欧美，反流性食管炎的发病率和严重程度也较低。预计日本 Barrett 食管腺癌的发病率不会像欧美那样高，将保持在 10%以下。
