Candida Overgrowth After Treatment of Duodenal Ulcer

Abstract

Acid-reducing drugs can cause increased growth of microbes, including fungus, because of high gastric pH. Our purpose was to evaluate the occurrence of mycotic infection in patients with duodenal ulcer on anti-ulcer therapy and to compare the effects of cimetidine, famotidine, and omeprazole. Eighty patients with duodenal ulcer (62 males and 18 female patients, 16-65 years old) were evaluated for mycotic infection before and after 6 weeks of therapy (cimetidine, 20 patients; famotidine, 40 patients; omeprazole, 20 patients). Mycotic infection was diagnosed by endoscopic biopsy from the ulcer edge subjected to smear, culture, and histopathology and by endoscopic brush samples and gastric aspirate. On the basis of these studies, patients were categorized as having no fungal growth, saprophytic growth, or significant fungal growth. Thirty-five (43.8%) patients had evidence of fungus before ulcer therapy, and 16 of the 35 (20%) had significant fungal growth. The fungal isolation rate was higher in older patients (> and = 45 years of age) and in those with an ulcer size > and = 2 cm. While there was no significant increase in the total number of patients with evidence of fungus after therapy (n = 36), there was a significant increase in those with significant growth (n = 27, p < 0.05) compared with pretreatment status. We found that posttreatment gastric pH of > and = 4 was associated with a higher fungal positivity rate (59.4%) than pH values < 4 (32.4%, p < 0.05). However, neither the type of drug used nor the response in terms of ulcer healing correlated with the presence of fungus. Regardless of the type of drug used, acid-reducing therapy is associated with increased significant fungal growth.

The Effect of Helicobacter pylori Infection, Aging, and Consumption of Proton Pump Inhibitor on Fungal Colonization in the Stomach of Dyspeptic Patients

“…Candida spp. have been isolated from gastric biopsies, the brush samples of gastric mucosa and peritoneal fluid and the frequency of fungal isolation was higher in older patients (Morishita et al, 1993 ; Goenka et al, 1996 ) or in those with hypochlorhydria (Goenka et al, 1996 ). Furthermore, among the 178 patients with benign gastric ulcer, there was a significant difference between the number of older patients at a mean age of 64.2 year with yeast in their histopathology preparation (36, 20.2%) and those with the mean age of 56.2 year without yeast (142, 79.8%; p < 0.01).…”

“…Factors favoring fungal colonization in the stomach have been described as old age, malnutrition, intravascular, or bladder catheterization, H2-blocker therapy and the use of wide-spectrum antibiotics (Scott and Jenkins, 1982 ; Savino et al, 1994 ). Hypochlorhydria due to atrophic gastritis, gastric surgery or use of proton pump inhibitors (PPIs) could also increase the risk of fungal infection (Goenka et al, 1996 ; Martinsen et al, 2005 ). While the clinical significance of fungi in gastric diseases is controversial (Eras et al, 1972 ) and the need for antifungal therapy has not been reached a consensus (Sasaki, 2013 ; von Rosenvinge et al, 2013 ), the etiologic role of H. pylori infection in the development of gastritis, peptic ulcers, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma has been widely accepted (Suerbaum and Michetti, 2002 ) and antimicrobial therapy measurements have been designed (Lam and Talley, 1998 ; Malfertheiner et al, 2012 ).…”

Inflammation and gastrointestinal Candida colonization

“…In several studies, Candida organisms were cultured from gastric biopsies, brush samples of mucosa or peritoneal fluid. Colonization was observed more frequently in older patients [35,36] and in patients with hypoacidity [36]. In addition, the rate of decrease in ulcer diameter, an indication of ulcer healing, was slower in patients whose stomachs were significantly colonized by Candida in comparison to patients who were not [37].…”

A Case of Stenotic Change from Gastric Candidiasis Managed with Temporary Stent Insertion

“…There are many conditions which are known to contribute to the colonization of Candida in gastrointestinal tract, especially in the stomach 7. Hypoacidity after treatment with H-2 receptor blockers or PPIs is associated with colonization of fungus at stomach, and impaired gastric emptying and stasis due to gastric resection or gastroneuropathy may also cause colonization by Candida 7.…”

“…Hypoacidity after treatment with H-2 receptor blockers or PPIs is associated with colonization of fungus at stomach, and impaired gastric emptying and stasis due to gastric resection or gastroneuropathy may also cause colonization by Candida 7. Other systemic disease, such as immune-deficiency status, especially HIV-infected patients, chronic alcoholism, malignancy or diabetes may predispose to invasive Candida infection in extraesophageal gastrointestinal tract 4,8.…”