• Department of Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
• Department of Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA; Department of Veterans Affairs New York Harbor Healthcare System, 423 East 23rd street, New York, NY 10010, USA; Department of Pathology, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
• Department of Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA. Electronic address: liying.yang@nyumc.org.

With the development of culture-independent technique, a complex microbiome has been established and described in the distal esophagus. The incidence of esophageal adenocarcinoma (EAC) has increased dramatically in the United States. Studies documenting an altered microbiome associated with EAC and its precedents suggest that dysbiosis may be contributing to carcinogenesis, potentially mediated by interactions with toll-like receptors. Investigations attempting to associate viruses with EAC have not been as consistent. Currently available data are cross-sectional and therefore cannot prove causal relationships. Prospectively, microbiome studies open a new avenue to the understanding of the etiology and pathogenesis of reflux disorders and EAC.