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In this review, we explore the normal esophageal flora and how it may be controlled, and also the variety of organisms that may affect esophageal carcinogenesis, either directly or indirectly. The organisms with potential direct effects in squamous cell carcinoma include human papillomavirus (HPV), Epstein\u2013Barr virus, and polyoma viruses. Interestingly, HPV is now implicated in esophageal adenocarcinoma (EAC), not in its initiation but in the development of dysplasia, in which HPV33 in particular has been associated. Indirectly, <jats:italic>Helicobacter pylori<\/jats:italic> has been associated with EAC by, initially, causing increased acid secretion that increases acid reflux, and by reducing lower esophageal sphincter pressure, which increases gastroesophageal reflux; the latter increases the risk of Barrett's esophagus, and hence EAC. Conversely, subsequent atrophic gastritis may normalize that risk.<\/jats:p>","DOI":"10.1111\/nyas.13858","type":"journal-article","created":{"date-parts":[[2018,5,31]],"date-time":"2018-05-31T10:36:17Z","timestamp":1527762977000},"page":"319-332","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Risk factors for esophageal cancer: emphasis on infectious agents"],"prefix":"10.1111","volume":"1434","author":[{"given":"Hala","family":"El\u2010Zimaity","sequence":"first","affiliation":[{"name":"Dynacare Laboratories  Brampton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Di Pilato","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Novella Ringressi","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine University of Florence  Florence Italy"},{"name":"Gastrointestinal Surgery Unit Florence Careggi University Hospital  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iva","family":"Brcic","sequence":"additional","affiliation":[{"name":"Institute of Pathology Medical University of Graz  Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanmugarajah","family":"Rajendra","sequence":"additional","affiliation":[{"name":"Gastro\u2010Intestinal Viral Oncology Group Ingham Institute for Applied Medical Research, Liverpool  Sydney New South Wales Australia"},{"name":"South Western Sydney Clinical School University of New South Wales, Kensington  Sydney New South Wales Australia"},{"name":"Department of Gastroenterology &amp; Hepatology Bankstown\u2010Lidcombe Hospital, South Western Sydney Local Health Network, Bankstown  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert","family":"Langer","sequence":"additional","affiliation":[{"name":"Institute of Pathology University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian","family":"Dislich","sequence":"additional","affiliation":[{"name":"Institute of Pathology Kantonsspital Baselland  Liestal Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Tripathi","sequence":"additional","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Guindi","sequence":"additional","affiliation":[{"name":"Department of Pathology and laboratory Medicine Cedars\u2010Sinai Medical Center  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Riddell","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Mount Sinai Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,5,31]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13073-016-0307-y"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature11234"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nmicrobiol.2016.49"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature08821"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro2974"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2012.10.003"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1600266"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1101\/gr.096651.109"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro3552"},{"key":"e_1_2_12_11_1","first-page":"764","article-title":"Aging and the human gut microbiota\u2010from correlation to causality","volume":"5","author":"Saraswati S.","year":"2014","journal-title":"Front. 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