Association of Helicobacter pylori and Epstein-Barr virus co-infection in gastric cancer patients: a prospective analytical study.

Authors

Anbarasan Sivamoorthy, Sathasivam Sureshkumar, Amaranathan Anandhi, Rahul Dhodapkar, Palanivel Chinnakali, Vikram Kate

Published in

Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery. Volume 39. Pages e1945. Epub Jul 10, 2026.

Abstract

Recent evidence suggests that Epstein-Barr virus (EBV) and Helicobacter pylori co-infection increase the prevalence of gastric cancer in the younger age group and are associated with poor prognosis. Identifying the association between these agents has important implications for the management of gastric cancer and also for defining populations at high risk of developing gastric malignancy.
To determine the prevalence of H. pylori and EBV co-infection in patients with gastric cancer.
This is a single-center prospective analytical study. A total of 182 patients were included. The study group (n=91) comprised all consecutive patients of age ≥18 years with gastric cancer. The control group (n=91) included individuals with normal endoscopy findings. Both groups were analyzed for the presence of H. pylori and EBV.
The overall prevalence of H. pylori infection in gastric cancer patients was 70.3%, EBV infection was 63.7%, and H. pylori and EBV co-infection was 51.6%. The H. pylori and EBV co-infection in the study and control groups was 51.6% versus 13.1% (p<0.001). The remaining parameters such as smoking, socioeconomic class, dietary habits, prior gastric surgery, tumor location, histological subtype, stage of the tumor, distant metastasis, and lymph node metastasis did not show any significance.
There was a significantly higher prevalence of EBV infection and H. pylori and EBV co-infection in patients with gastric cancer. The prognostic and therapeutic role of co-infection requires long-term follow-up and assessment of treatment response.
The strongest known environmental risk factor for developing gastric cancer is prolonged colonization with Helicobacter pylori. More than 50% of the world's population harbors H. pylori in the gastric mucosa. Epstein-Barr virus (EBV), which is associated with many hematological malignancies, is now considered to be associated with the development of gastric cancer. Studies have reported that 9% of gastric cancer cases are associated with EBV infection. The association of EBV and H. pylori co-infection in gastric cancer has not been extensively investigated.
Epstein-Barr virus (EBV) infection appears to be more prevalent in gastric cancer compared to the normal population. Also, most of the gastric cancer patients have co-infection of both Helicobacter pylori and EBV. The importance of this observation indicates that H. pylori eradication alone does not help in the prevention of gastric cancer. EBV infection, which augments the damage caused by H. pylori, requires a specific targeted therapy. In the future, individuals with a high risk of gastric cancer may benefit from the targeted drug against the EBV-lytic cycle protein, with the aim of preventing reactivation of the virus.

PMID:
42454829
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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