A perspective on risk factors for esophageal adenocarcinoma: emphasis on Helicobacter pylori infection

Abstract

Gastroesophageal reflux disease (GERD) and the increasing rate of its associated complications, including esophageal adenocarcinoma (EAC), has stimulated a plethora of studies attempting to evaluate provocative and protective factors. Helicobacter pylori (Hp) infection (Hp-I) was initially considered as a beneficial condition in GERD management based on rather limited data. Large-scale regional studies revealed an alternative approach, by suggesting a positive relationship between Hp-I and EAC development. Regarding pathophysiology, Hp-I induces gastric microbiota disturbances through hypochlorhydria and chronic inflammation, with a subsequent possible effect on the GERD−Barrett's esophagus (BE)−EAC cascade. Additionally, both direct effects on esophageal mucosa and indirect effects on known mechanisms of GERD, such as acid pocket and transient lower esophageal sphincter relaxation, remain to be elucidated. Hp contribution to carcinogenesis is related to oncogenic gastrin, cyclooxygenase-2, and prostaglandins; Ki-67 is also expressed and represents an index of BE-related malignancy. Moreover, Hp-I is vigorously suggested as a risk factor for metabolic syndrome, which may be the link between Hp-I and EAC. Although further studies are necessary to establish a pathophysiologic risk between Hp-I and the GERD−BE−EAC sequence, the theory of Hp protection against GERD seems outdated.

Letter: Helicobacter pylori in proton pump inhibitor‐associated biliary disease

“…This observational result could include unrecognized confounders, one of which to consider being the overlap between Helicobacter pylori infection (Hp-I) and the conditions treated using a PPI; dyspepsia, peptic ulcer disease and, at least in some populations, gastro-oesophageal reflux disease-Barrett's oesophagusoesophageal cancer sequence are associated with Hp-I and represent the most frequent indications for PPI prescription. 2 Moreover Hp-I is involved in PPI-related disorders discussed by the authors. [1][2][3] The impact of Hp-I with biliary tree diseases has been described.…”

“…2 Moreover Hp-I is involved in PPI-related disorders discussed by the authors. [1][2][3] The impact of Hp-I with biliary tree diseases has been described.…”

“…In recent issues of Alimentary pharmacology & Therapeutics, two studies showed that TDF reduces the incidence of HCC in CHB patients. 1,2 However, neither of these two studies directly compared the efficacy of TDF with entecavir. The efficacy of TDF and entecavir in preventing HCC incidence in CHB patients is controversial in recent large cohort studies.…”

Letter:Helicobacter pyloriinfection and its role in oesophageal adenocarcinoma

“…The inconsistencies between H pylori-related oncogenesis data, H pylori status, and progression of the gastro-oesophageal reflux disease (GERD) -Barrett oesophagus (BO) -OAC sequence clearly merits further study. [2][3][4][5][6] The pathogenesis of GERD involves excessive transient lower oesophageal sphincter relaxations (TLOSRs) and imbalance between oesophageal mucosa acidic injury and clearance mechanisms.…”

Influence of Helicobacter pylori‐connected metabolic syndrome on non‐alcoholic fatty liver disease and its related colorectal neoplasm high risk

“…The recent study also reported an impact of Hp-I related metabolic syndrome on lower gastrointestinal tract oncogenesis 1. There is growing evidence for a potential association between Hp-I and NAFLD and malignancies 2. Hp-I induces overexpression of cyclooxygenase-2 and inflammatory changes in colorectal mucosa leading to cancerogenesis 3.…”