Relationship Between Helicobacter pylori Infection and Esophageal Neoplasia: A Meta-analysis

Background & Aims:Helicobacter pylori is an important causative factor in gastric carcinogenesis. However, its role in extragastric gastrointestinal malignancies, such as esophageal cancer, is controversial. The aim of this study was to explore the relationship of H pylori infection and H pylori cagA-positive strain with this malignancy by performing meta-analysis of all relevant studies. Methods: Extensive MEDLINE English language medical literature searches for human studies were performed through February 2007 with suitable keywords. Pooled estimates were obtained by using fixed or random-effects model as appropriate. Heterogeneity between studies was evaluated with the Cochran Q test, whereas the likelihood of publication bias was assessed by constructing funnel plots. Their symmetry was estimated by the Begg and Mazumdar adjusted rank correlation test. Results: In adenocarcinoma patients there were inverse significant relationships with both the H pylori prevalence (pooled odds ratio [OR], 0.52; 95% confidence interval [CI], 0.37-0.73; P < .001) and the prevalence of H pylori cagA-positive strain (pooled OR, 0.51; 95% CI, 0.31-0.82; P = .006). Similarly in patients with Barrett's esophagus there were inverse significant relationships (pooled OR, 0.64; 95% CI, 0.43-0.94; P = .025 and pooled OR, 0.39; 95% CI, 0.21-0.76; P = .005, respectively). In patients with squamous cell carcinoma there were no significant relationships with both H pylori prevalence (pooled OR, 0.85; 95% CI, 0.55-1.33; P = .48) and the prevalence of H pylori cagA-positive strains (pooled OR, 1.22; 95% CI, 0.7-2.13; P = .48). Conclusions: The results showed an inverse statistically significant relationship of H pylori infection with both esophageal adenocarcinoma and Barrett's esophagus, which might suggest a protective role of the infection in these entities. On the contrary, no statistically significant relationship with squamous cell carcinoma was found.