Abstract
Introduction: Helicobacter pylori (HP) is the most common cause of peptic ulcers in the gastrointestinal tract (GIT) and has been linked to various GIT malignancies, especially gastric cancer. There is little data on the association between HP infection and esophageal cancer incidence (EC). Therefore, we aimed to conduct this meta-analysis to investigate the effect of HP infection on the risk of developing esophageal cancer. Methods: We searched PubMed and the CINHAL databases for studies reporting the association between H. pylori infection and esophageal cancer from inception to September 2020. We assessed the relationship between H. Pylori infection and the incidence of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) using odds ratio (OR) and relative 95% confidence intervals (CI). Two investigators extracted the data independently, and discrepancies were resolved by discussion with a third investigator. We used RevMan Software to perform the analysis and assessed the heterogeneity using the I2 statistic. Results: This meta-analysis included 45 studies. Total HP positive cases were 311,974 and 38,188 in the ESCC and EAC group, respectively. No statistically significant difference was found between HP and ESCC (OR = 1.10, 95% CI [0.80-1.52], P = 0.55). However, according to region, the subgroup analysis revealed a significantly higher incidence of ESCC with HP (OR = 1.83, 95% CI [1.17-2.87]) for North America. There was a statistically significant reduction in EAC with HP in the overall study population (OR = 0.54, 95% CI [0.34-0.87], P = 0.01). Subgroup analysis showed that western countries were associated with statistically reduced EAC incidence (OR = 0.51, 95% CI [0.32-0.83]). On the other hand, subgroup analysis of eastern countries reported non-significant results (OR = 0.81, 95% CI [0.15-4.30]). Conclusion: Overall, no significant association was found between H. pylori infection and the risk of ESCC. There was a statistically significant reduction in EAC with HP in the overall study population. In subgroup analysis a significantly increased incidence of ESCC is seen in North America and a significantly reduced risk of EAC in western countries. Further randomized controlled trials are need to investigate the protective effect of helicobacter pylori infection for risk of esophageal adenocarcinoma.
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