Clinical Characteristics and Manifestations of Fungal Esophagitis: A Single-Center Experience in South China

Abstract

Fungal esophagitis is a common infectious disease, although the pathogenic clinical characteristics remain incompletely clear, especially in South China. The goal of this study was to investigate the pathogenic clinical characteristics of fungal esophagitis and the efficacy of different therapeutic strategies at a tertiary hospital in South China. A retrospective study was conducted from January 2007 to December 2017. Data from 113,390 patients who were treated in the endoscopic unit were retrieved and analyzed. To further understand the pathogen and risk factors for fungal esophagitis, we performed a case-control analysis of 101 patients and 202 controls. Of the 113,390 patients, 932 (0.82%) were positive. The annual detection rate ranged from 0.345% to 1.106%, showing an initially increasing and subsequently decreasing trend. The patients’ median age was 49 years (range from 8 to 85), and most were men (615/932, 65.99%). Candida albicans was found in samples collected from 36 patients, without any drug-resistant strains. Age ( P = 0.018 ), malignancy ( OR = 4.031 , 95% CI: 1.562~10.407), cigarette smoking ( OR = 3.017 , 95% CI: 1.645~5.533), and the use of antibiotics ( OR = 2.178 , 95% CI: 1.078~4.400) or immunosuppressants ( OR = 6.525 , 95% CI: 1.089~39.105) were independently associated with esophageal candidiasis. Fluconazole had a better curative effect than nystatin ( OR = 4.047 , 95% CI: 1.282~12.772) or simple observation ( OR = 8.91 , 95% CI: 2.61~30.49). In conclusion, fungal esophagitis primarily affects men and elderly individuals; it develops in the setting of malignancy, smoking, and certain previous medication use. Candida albicans is the most common pathogen and is sensitive to antifungal agents. Fluconazole has a good therapeutic effect.

Predictors of Underlying Esophageal Motility Disorders in Patients Presenting with Esophageal Candidiasis

“…What is surprising is that although the association of EC with EMDs has been known for many years, the majority of the studies on predictors and risk factors for EC have failed to even mention EMDs 2–10 . It is therefore not clear which EMDs are found in EC, when they are diagnosed, and which symptoms and findings suggest an underlying EMD.…”

“…Candida species are known to colonize the mucosa of the alimentary tract, but in the setting of local or systemic immune system impairment, overgrowth may occur. Numerous studies have evaluated and described the predictors and risk factors for EC 2–10 . These include immunosuppression from HIV; associated medical conditions such as diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, and cancer; and the use of medications including chemotherapy, glucocorticoid steroids, antibiotics, and proton pump inhibitors.…”

“…Given this known relation, it has been suggested that immunocompetent patients with EC should be evaluated for underlying EMDs, although no guidelines recommend this 11 . Despite this well-established association, it is surprising that most studies investigating the risk factors for EC have failed to even evaluate for the presence of EMDs 2–10 …”

“…Numerous studies have evaluated and described the predictors and risk factors for EC. [2][3][4][5][6][7][8][9][10] These include immunosuppression from HIV; associated medical conditions such as diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, and cancer; and the use of medications including chemotherapy, glucocorticoid steroids, antibiotics, and proton pump inhibitors.…”

Candida albicans: An orthodontic point of view

“…Oral candidiasis usually occurs secondary to immunosuppression, either due to decreased immune function in the patient's mouth or systemically, being sensitive to antifungal agents [31,32] . Patients on antifungal treatment showed significant improvement to the oral mucosal condition.…”