Reflux esophagitis--Japan and Western countries

Although reflux esophagitis (RE) is a common disease of the upper gastrointestinal tract in Western countries, its prevalence is still low in Asian countries, including Japan. On the other hand, the prevalence of H. pylori infection and atrophic gastritis are very high in Japan in comparison to that of other developed countries. Atrophic gastritis decreases gastric acid secretion, which is much lower in the Japanese compared to that in Western persons. The main mechanism of RE is reflux of gastric acid into the esophagus from the stomach. A decrease in gastric acid secretion induced by atrophic gastritis might prevent this acid reflux. This may be the reason RE is an uncommon disease in Japan.