There is growing evidence that gastroesophageal disease is significantly influenced by the microbiome of the esophagus. Additionally, the commensal microbiome of the oropharynx, stomach, and colon have a role in its pathogenesis. Changes to the composition of the normal esophageal flora, notably a transition from Grampositive to predominantly Gram-negative, is thought to promote disease susceptibility. Diseases of the esophagus, which include gastroesophageal reflux, Barrett's esophagus, esophageal cancer, esophageal dysmotility, as well as eosinophilic esophagitis. These are all characterized by an inflammatory-mediated cascade thought to be propagated, in part, potentially by an imbalance of commensal microbes.In addition to activation of the inflammatory cascade, potentiation of dysbiosis itself may be a consequence of dysbiotic changes in bacterial composition. Bacteriocins are inhibitory polypeptides produced by bacteria, which may play an integral role in further progression to dysbiotic states by inhibiting growth of commensal flora. Accordingly, this may present an avenue for disease mitigation by shifting the composition of the microbial community towards an eubiotic state.Therapeutic options targeting the microbiome, including prebiotics, probiotics, antibiotics, as well as bacteriocins have been studied. This review focuses on the current knowledge of the involvement of the microbiome in esophageal diseases (most notably GERD/Barrett's esophagus/esophageal cancer) and identifies emerging new concepts for treatment.