Helicobacter pylori infection and esophageal cancer

Q: H. pylori infection may be protective against esophageal adenocarcinoma?

A) True

B) False

Answer: A

Paradoxical to conceptual thinking, H. pylori infection appears to be protective against gastroesophageal reflux disease (GERD), Barrett's esophagus (BE) induced dysplasia, and subsequently to esophageal adenocarcinoma.

The possible explanations for this surprising paradox are two. First, the chronic gastritis from H. pylori infection interferes with the acid production and so protects against BE. Second, H. pylori strains that express cytotoxin-associated gene A (cagA) appear to be especially damaging to the stomach but especially protective for the esophagus. 

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References:

1. Erőss B, Farkas N, Vincze Á, et al. Helicobacter pylori infection reduces the risk of Barrett's esophagus: A meta-analysis and systematic review. Helicobacter 2018; 23:e12504.

2. Castro C, Peleteiro B, Lunet N. Modifiable factors and esophageal cancer: a systematic review of published meta-analyses. J Gastroenterol 2018; 53:37.