Ongoing changes in endoscopic appearance of the esophageal-gastric junction and stomch in young Japanese

Background This study examines the ongoing changes in endoscopic appearance of the esophageal-gastric junction and gastric mucosa that correlate with improved gastric mucosal health and adoption of a high protein diet in Japan.
Methods This was a retrospective study of young Japanese adults (ages between 19 and 30 years) undergoing esophagogastroduodenoscopy for upper gastrointestinal symptoms between 2006 and 2019. The changes in the appearance of the esophago-gastric junction (i.e., the Z-line and distal esophagitis) and gastric mucosa were examined.
Results A total of 1725 patients were evaluated; 848 from 2006 to 2012 [400 males, average age, 26.5 years (range, 19-30)] and 877 from 2013 to 2019 [381 males, average age, 26.1 years (range, 19-30)]. The proportion with endoscopic reflux esophagitis and endoscopic Barrett’s esophagus increased significantly between the two periods (19.5% vs. 29.5%, P<0.001; 12.5% vs. 22.4%, P<0.001) with a significant correlation between the trends in endoscopic Barrett’s esophagus and gastric fundic gland polyps (r=0.745, P=0.001). A patient with esophageal adenocarcinoma was found in the latter period.
Conclusions The ongoing improvement is gastric mucosal health and dietary changes in young Japanese adults imply increasing westernization of the Japanese stomach and may be the harbinger of an increase in esophageal adenocarcinoma as has occurred in the West.