Role of gastric acid secretion in the pathogenesis of Barrett's esophageal cancer in a Japanese population.

The acidity of the refluxate into the esophagus is an important factor not only for reflux esophagitis, but also for Barrett's esophagus and the development of Barrett's esophageal cancer. On the other hand, H. pylori infection is thought to prevent reflux esophagitis and Barrett's esophagus by causing atrophic gastritis, which in turn decreases gastric acid secretion. Moreover, the preservation of gastric acid secretion may be important for the development of gastroesophageal junction cancer, including Barrett's esophageal cancer, irrespective of the H. pylori infection status. An increase in gastric acid secretion in Japanese populations has been predicted based on a decreasing rate of H. pylori infection and the westernization of eating habits in Japan; this, in turn, may lead to an increase in the prevalence of Barrett's esophageal cancer in Japan in the future.