Helicobacter pylori infection and esophageal cancer risk: an updated meta-analysis

World J Gastroenterol. 2013 Sep 28;19(36):6098-107. doi: 10.3748/wjg.v19.i36.6098.

Abstract

Aim: To clarify the association between Helicobacter pylori (H. pylori) infection and the risk of esophageal carcinoma through a meta-analysis of published data.

Methods: Studies which reported the association between H. pylori infection and esophageal cancer published up to June 2013 were included. The odds ratios (ORs) and corresponding 95%CIs of H. pylori infection on esophageal cancer with respect to health control groups were evaluated. Data were extracted independently by two investigators and discrepancies were resolved by discussion with a third investigator. The statistical software, STATA (version 12.0), was applied to investigate heterogeneity among individual studies and to summarize the studies. A meta-analysis was performed using a fixed-effect or random-effect method, depending on the absence or presence of significant heterogeneity.

Results: No significant association between H. pylori infection and esophageal squamous cell carcinoma (ESCC) risk was found in the pooled overall population (OR = 0.97, 95%CI: 0.76-1.24). However, significant associations between H. pylori infection and ESCC risk were found in Eastern subjects (OR = 0.66, 95%CI: 0.43-0.89). Similarly, cytotoxin-associated gene-A (CagA) positive strains of infection may decrease the risk of ESCC in Eastern subjects (OR = 0.77, 95%CI: 0.65-0.92), however, these associations were not statistically significant in Western subjects (OR = 1.26, 95%CI: 0.97-1.63). For esophageal adenocarcinoma (EAC) the summary OR for H. pylori infection and CagA positive strains of infection were 0.59 (95%CI: 0.51-0.68) and 0.56 (95%CI: 0.45-0.70), respectively.

Conclusion: H. pylori infection is associated with a decreased risk of ESCC in Eastern populations and a decreased risk of EAC in the overall population.

Keywords: Cancer risk; Esophageal carcinoma; Helicobacter pylori; Meta-analysis.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / epidemiology*
  • Adenocarcinoma / microbiology
  • Asia / epidemiology
  • Asian Continental Ancestry Group
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / epidemiology*
  • Carcinoma, Squamous Cell / microbiology
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / epidemiology*
  • Esophageal Neoplasms / microbiology
  • Esophageal Squamous Cell Carcinoma
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / epidemiology*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / isolation & purification*
  • Humans
  • Odds Ratio
  • Prognosis
  • Risk Factors