Erosive esophagitis and Barrett's esophagus in Taiwan: a higher frequency than expected

In contrast to Western countries, erosive esophagitis has been considered less common, Barrett's esophagus presumed less frequent, and hiatal hernia extremely uncommon in the Orient. However, accelerated modernization and adoption of Western customs have resulted in marked life-style changes in many Asians in the Orient that may potentially affect the frequency of erosive esophagitis and Barrett's esophagus in this population. Our aim was to determine the current frequency of erosive esophagitis, Barrett's esophagus, and other gastroesophageal reflux disease complications in self-referred Chinese patients undergoing upper gastrointestinal endoscopy in Taipei, Taiwan. Between July 1991 and June 1992, 464 consecutive patients underwent endoscopy for a variety of upper gastrointestinal symptoms at a major medical center. The presence of erosive esophagitis, strictures, Barrett's esophagus, and hiatal hernia was recorded. The extent of mucosal injury was determined by using the Savary-Miller grading system. Sixty-six (14.5%) patients were found to have erosive esophagitis, 9 (2%), Barrett's esophagus, and 32 (7%) hiatal hernias. Erosive esophagitis showed a male-to-female preponderance of 3.1:1. Disease severity increased with age and peaked during the sixth and seventh decades. We concluded that in contrast to previous experience, the Chinese population in Taiwan appears to have a higher frequency of erosive esophagitis, Barrett's esophagus, and hiatal hernia. Increased fat consumption, aging, and other possible factors are suggested as possible mechanisms.