The prevalence of viral agents in esophageal adenocarcinoma and Barrett's esophagus: A systematic review

Andrew T. Kunzmann*, Suzanne Graham, Charlene M. McShane, James Doyle, Massimo Tommasino, Brian Johnston, Jackie Jamison, Jacqueline A. James, Damian McManus, Lesley A. Anderson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

22 Citations (Scopus)


Background and aims: Human papilloma virus (HPV), which may reach the esophagus through orogenital transmission, has been postulated to be associated with esophageal adenocarcinoma (EAC). A systematic review of the literature investigating the prevalence of infectious agents in EAC and Barrett's esophagus (BE) was carried out. Methods: Using terms for viruses and EAC, the Medline, Embase, and Web of Science databases were systematically searched for studies published, in any language, until June 2016 that assessed the prevalence of viral agents in EAC or BE. Random-effects meta-analyses of proportions were carried out to calculate the pooled prevalence and 95% confidence intervals (CIs) of infections in EAC and BE. Results: A total of 30 studies were included. The pooled prevalence of HPV in EAC tumor samples was 13% (n=19 studies, 95% CI: 2-29%) and 26% (n=6 studies, 95% CI: 3-59%) in BE samples. HPV prevalence was higher in EAC tissue than in esophageal tissue from healthy controls (n=5 studies, pooled odds ratio=3.31, 95% CI: 1.15-9.50). The prevalence of Epstein-Barr virus (EBV) in EAC was 6% (n=5, 95% CI: 0-27%). Few studies have assessed other infectious agents. For each of the analyses, considerable between-study variation was observed (I2=84-96%); however, sensitivity analyses did not show any major sources of heterogeneity. Conclusion: The prevalence of HPV and EBV in EAC is low compared with other viral-associated cancers, but may have been hampered by small sample sizes and detection methods susceptible to fixation processes. Additional research with adequate sample sizes and high-quality detection methods is required.

Original languageEnglish
Pages (from-to)817-825
Number of pages9
JournalEuropean Journal of Gastroenterology and Hepatology
Issue number7
Publication statusPublished - 31 Jul 2017


  • Barretts esophagus
  • esophageal adenocarcinoma
  • infectious agents
  • systematic review


Dive into the research topics of 'The prevalence of viral agents in esophageal adenocarcinoma and Barrett's esophagus: A systematic review'. Together they form a unique fingerprint.

Cite this