Skip to main content
Log in

Erosive Esophagitis and Barrett's Esophagus in Taiwan (A Higher Frequency than Expected)

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

In contrast to Western countries, erosiveesophagitis has been considered less common, Barrett'sesophagus presumed less frequent, and hiatal herniaextremely uncommon in the Orient. However, accelerated modernization and adoption of Western customshave resulted in marked life-style changes in manyAsians in the Orient that may potentially affect thefrequency of erosive esophagitis and Barrett's esophagus in this population. Our aim was to determinethe current frequency of erosive esophagitis, Barrett'sesophagus, and other gastroesophageal reflux diseasecomplications in self-referred Chinese patients undergoing upper gastrointestinal endoscopy inTaipei, Taiwan. Between July 1991 and June 1992, 464consecutive patients underwent endoscopy for a varietyof upper gastrointestinal symptoms at a major medical center. The presence of erosive esophagitis,strictures, Barrett's esophagus, and hiatal hernia wasrecorded. The extent of mucosal injury was determined byusing the Savary-Miller grading system. Sixty-six (14.5%) patients were found to have erosiveesophagitis, 9 (2%), Barrett's esophagus, and 32 (7%)hiatal hernias. Erosive esophagitis showed amale-to-female preponderance of 3.1:1. Disease severityincreased with age and peaked during the sixth andseventh decades. We concluded that in contrast toprevious experience, the Chinese population in Taiwanappears to have a higher frequency of erosiveesophagitis, Barrett's esophagus, and hiatal hernia.Increased fat consumption, aging, and other possiblefactors are suggested as possible mechanisms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Nebel OT, Fornes MF, Castell DO: Symptomatic gastroesophageal reflux: Incidence and precipitating factors. Am J Dig Dis 21:953–956, 1976

    Google Scholar 

  2. Thompson WG, Heaton KW: Heartburn and globus in apparently healthy people. Can Med Assoc J 126:46–48, 1982

    Google Scholar 

  3. The Gallup Organization: Gallup survey on heartburn across America, March 28, 1988

  4. Chen PC, Wu CS, Chang-Chien SC, Liaw YF: Comparison of Olympus GIF-P2 and GIF-K pandndoscopy. Taiwan I Hsueh Hui Tsa Chih J Formosan Med Assoc 78:136–140, 1979

    Google Scholar 

  5. Burkitt DP, James PA: Low-residue diets and hiatus hernia. Lancet 2:128–130, 1973

    Google Scholar 

  6. Spechler SJ, Goyal RK: Barrett's esophagus. N Engl J Med 31:362–371, 1986

    Google Scholar 

  7. Savary M, Miller G: The Esophagus. Handbook and Atlas of Endoscopy. Geneva, Gassmann AG, 1978, 135

    Google Scholar 

  8. Blackstone MD: Endoscopic Interpretation: Normal and Pathologic Appearance of the Gastrointestinal Tract. New York: Raven Press 1984

    Google Scholar 

  9. Stoker DL, Williams JG, Leicester RG, Colin-Jones DG: Oesophagitis—a five year review. Gut 29:A1450, 1988

    Google Scholar 

  10. Naef AP, Savary M, Ozzello L: Columnar-lined lower esophagus: An acquired lesion with malignant predisposition. J Thorac Cardiovasc Surg 70:826–835, 1975

    Google Scholar 

  11. Johnson LF, DeMeester TR: Twenty-four hour pH monitoring of the distal esophagus. Am J Gastroenterol 62:325–332, 1974

    Google Scholar 

  12. Munoz N, Crespi M, Grassi A, Guo-Quing W, Qiong S, Cai LZ: Precursor lesions of esophageal cancer in high-risk populations in Iran and China. Lancet 1:876–879, 1982

    Google Scholar 

  13. Crespi M, Grassi A, Munoz N, Guo-Quing W, Guan-Rei Y: Endoscopic features of suspected precancerous lesions in high risk areas for esophageal cancer Endoscopy 16:85–91, 1984

    Google Scholar 

  14. Crespi M, Munoz N, Grassi A, Qiong S, Jing WK, Jien LJ: Precursor lesions of oesophageal cancer in a low risk population in China: Comparison with high-risk population. Int J Cancer 34:599–602, 1984

    Google Scholar 

  15. Mirvish SS, Huang Q, Chen SC, Birt DF, Clark GWB, Hinder RA, Smyrk TC, DeMeester TR: Metabolism of carcinogenic nitrosamines in the rat and human esophagus and induction of esophageal adenocarcinoma in rats. Endoscopy 25(suppl):627–631, 1993

    Google Scholar 

  16. Wang THE, Lai MY, Lin RT, Wu CF, Chen DS, Wang CY, et al: Clinical experience with the upper gastrointestinal panendoscope GIF-P2 (Olympus). Taiwan I Hsueh Hui chin (J Formosan Med Assoc) 77:778–783, 1978

    Google Scholar 

  17. Spechler SJ: Epidemiology and natural history of gastrooesophageal reflux disease. Digestion 5(suppl 1):24–29, 1992

    Google Scholar 

  18. Monnier PH, Savary M: Contribution of endoscopy to gastrooesophageal reflux disease. Scand J Gastroenterol 19(suppl 106):27–44, 1984

    Google Scholar 

  19. Burbige EJ, Radigan JJ: Characteristics of the columnar-cell lined (Barrett's) esophagus. Gastrointest Endosc 25:133–136, 1979

    Google Scholar 

  20. Rothery GA, Patterson JE, Stoddard CJ, et al: Histological and histochemical changes in the columnar lined (Barrett's) oesophagus. Gut 27:1062–1068, 1986

    Google Scholar 

  21. Cooper BT, Barbezat GO: Barrett's oesophagus: A clinical study of 52 patients. Q J Med 62:97–108, 1987

    Google Scholar 

  22. Herlihy KJ, Orlando RC, Bryson JC, et al: Barrett's esophagus: clinical endoscopic, histologic, manometric and electrical potential difference characteristics. Gastroenterology 86:436–443, 1984

    Google Scholar 

  23. Ovaska J, Miettinen M, Kivilaakso E: Adenocarcinoma arising in Barrett's esophagus. Dig Dis Sci 34:1336–1339, 1989

    Google Scholar 

  24. Mann NS, Tasi MF, Nair PK: Barrett's esophagus in patients with symptomatic reflux esophagitis. Am J Gastroenterol 84:1494–1496, 1989

    Google Scholar 

  25. Winters C, Spurling TJ, Chobanian SJ, et al: Barrett's esophagus: A prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology 92:118–124, 1987

    Google Scholar 

  26. Cameron AJ, Zinsmeister AR, Ballard DJ, et al: Prevalence of columnar-lined (Barrett's) esophagus. Comparison of population-based and autopsy findings. Gastroenterology 99:918–922, 1990

    Google Scholar 

  27. Mittal RK, Lange RC, McCallum RW: Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia. Gastroenterology 92:130–135, 1987

    Google Scholar 

  28. Sloan S, Kahrilas PJ: Impairment of esophageal emptying with hiatal hernia. Gastroenterology 100:596–605, 1991

    Google Scholar 

  29. Pope CE: Acid-reflux disorders. N Engl J Med 331:656–660, 1994

    Google Scholar 

  30. Boyle JT, Altschuler SM, Nixon TE, et al: Role of the diaphragm in the genesis of lower esophageal sphincter pressure in the cat. Gastroenterology 88:723–730, 1985

    Google Scholar 

  31. Aldridge NH: Transmigration of the lower esophageal mucosa. Radiology 79:962–967, 1962

    Google Scholar 

  32. Berstad A, Weberg R, Fryshov Larson I, et al: Relationship of hiatus hernia to reflux esophagitis. A prospective study of coincidence, using endoscopy. Scand J Gastroenterol 21:55–58, 1986

    Google Scholar 

  33. Sontag SJ, Schnell TG, Miller TQ, et al: The importance of hiatal hernia in reflux esophagitis compared with lower esophageal sphincter pressure or smoking. J Clin Gastroenterol 13:628–643, 1991

    Google Scholar 

  34. Ott DJ, Dodds WJ, Wu WC, et al: Current status of radiology in evaluating for gastroesophageal reflux disease. J Clin Gastroenterol 4:365–375, 1982

    Google Scholar 

  35. Nebel OT, Castell DO: Lower esophageal sphincter pressure change after food ingestion. Gastroenterology 63:778–783, 1972

    Google Scholar 

  36. Ireland A, Lyrenas E, Tippett M: Provocation of transient lower esophageal sphincter relaxations and gastroesophageal reflux by intraduodenal fat. Gastroenterology 98:A361, 1990

    Google Scholar 

  37. Department of Health: Directory of Nutrition for People of the Republic of China. Executive Yuan, Republic of China, 1991

    Google Scholar 

  38. Yasukochi H: The incidence of gastroesophageal reflux: Aging and circumstances factor. Nippon Igaku Hoshasen Gakkai Zasshi (Nippon Acta Radiol) 47:1529–1534, 1987

    Google Scholar 

  39. Inoue M, Sekiguchi T, Harasawa S, et al: Dyspepsia and dyspepsia subgroups in Japan: Symptom profiles and experience with cisapride. Scand J Gastroenterol 28(suppl 195):36–39, 1993

    Google Scholar 

  40. Department of Statistics: Handbook of Statistics of Internal Affairs. Ministry of interior, Republic of China, 1993

    Google Scholar 

  41. Mold JW, Reed LE, Davis AB, et al: Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. Am J Gastroenterol 86:965–970, 1991

    Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yeh, C., Hsu, CT., Ho, AS. et al. Erosive Esophagitis and Barrett's Esophagus in Taiwan (A Higher Frequency than Expected). Dig Dis Sci 42, 702–706 (1997). https://doi.org/10.1023/A:1018835324210

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1018835324210

Navigation