Alcohol drinking is considered a risk factor for esophageal cancer, and exposure to high levels of acetaldehyde, the principal metabolite of alcohol, may be responsible. Individuals homozygous for the *2 variant allele of aldehyde dehydrogenase 2 (ALDH2) are unable to metabolize acetaldehyde, which prevents them from alcohol drinking, whereas those with *1/*2 have a 6-fold higher blood acetaldehyde concentration postalcohol consumption with respect to *1*1. We carried out a meta-analysis of ALDH2 and esophageal cancer searching for relevant studies on Asians in Medline and EMbase up to May 2011, and investigated the association between this genotype variation and esophageal cancer risk. A total of 2,697 cases and ,6344 controls were retained for the analysis. The pooled OR (95% CI) for ALDH2*1/*2 was 2.47 (95%CI: 1.76-3.46) compared with ALDH2*1/*1. ALDH2*2/*2 showed a non-significant decreased risk for esophageal cancer with OR of 0.6 (0.26-1.38). ALDH2*1/*2 individuals showed a higher risk of esophageal cancer among moderate and heavy alcohol users [2.17(1.95-2.43) and 3.20(2.78-3.70), respectively]. Moderate drinkers with ALDH2*2/*2 showed strong esophageal cancer risk [OR(95%CI)=8.52(3.81-19.04)] compared with ALDH2*1/*1 carriers among heavy drinkers than non-drinkers and moderate drinkers (OR=7.05). Our finding showed that ALDH2*1/*2 genotype increases the risk of esophageal cancer, while the ALDH2*2/*2 genotype reduces the risk, presumably preventing people from consumption due to discomfort. Drinking clearly modifies the effect of ALDH2 on esophageal cancer risk in Asians.
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