Gastrointestinal and liver disease in the Asian Pacific region-Changing trends and future perspectives
|演者||Goh Khean-Lee（Asian Pacific Association of Gastroenterology（APAGE）/Division of Gastroenterology and Herpatology, Department of Medicine, University of Malaya, Malaysia）|
|抄録|| The new millennium has seen distinct changes in the pattern of gastrointestinal disease in the Asian Pacific region. These changes are important as more than half the world’s population come from the region and therefore impact significantly on the global disease burden. The highest gastric cancer（GCA）incidences have been reported from Asia and GCA remains a very important cancer. Recent trends, however show a decrease in GCA incidence in several countries in Asia. A rise in cardio-esophageal cancers as seen in the West has not been reported. On the other hand, colorectal cancer（CRC）has been steadily increasing in Asia with age-standardized incidences（ASR）of some countries approaching that of the West.
The pattern of acid related diseases has also changed. Gastroesophageal reflux disease（GERD）is a fast emerging disease. The prevalence of peptic ulcer disease has at the same time declined. H.pylori infection has also decreased in prevalence and may underlie the observed changes in the pattern of UGI disease. Inflammatory bowel disease：ulcerative colitis and Crohn’s disease has also shown an increase in prevalence. NSAID associated GI disease, non-alcoholic fatty liver disease（NAFLD）are also increasing in Asia.
Obviously these changes do not occur in a consistent manner in a diverse continent such as Asia where distinct geographical and ethnic differences exist. Many of the changes taking place mirror the Western experience which had taken place several decades ago. Astute observation of the epidemiology of emerging diseases combined with good scientific work will allow a clear understanding of the key pathogenic processes of these diseases.
In a broad sense, changes in disease prevalence and pattern in our region follow the dramatic socio-economic changes that have been taking place in Asia. Lifestyle and other environmental changes, Westernization of our diets have been blamed for an increase in several diseases including GERD, NAFLD and CRC. A worrying trend has been the increase in obesity amongst Asian which leads not only to an increase in metabolic diseases but to various GI cancers as well. Conversely, an improvement in living conditions is closely linked to the decrease in GCA and H.pylori prevalence.