Prevalence of Esophageal Candidiasis Induced by Inhaled Corticosteroids

Castro-Coelho, A.; Aun, Marcelo Vívolo; Montenegro, F.G.; Bisaccioni, Carla; Kalil, Jorge; Agondi, Rosana Câmara; Giavina‐Bianchi, Pedro

doi:10.1016/j.jaci.2009.12.273

Cited by 2 publications

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“…While Takahashi et al (8) found systemic corticosteroids were an independent risk factor for FE in adults, only 2 participants in our study had a recent history of oral corticosteroid use, and therefore no reliable conclusions were derived from this data. There is conflicting evidence that inhaled corticosteroids lead to an increased risk of FE (4,16,(32)(33)(34)(35)(36), which may explain our findings of non-significance for this variable.…”

Section: Topical Swallowed Corticosteroidscontrasting

confidence: 65%

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Correia,

Weber,

Krishnan

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Fungal esophagitis (FE) is the most common cause of esophageal infection and its prevalence in immunocompetent adults is rising. However, there is minimal data on FE in children without human immunodeficiency virus. Therefore, the objective of this study was to determine the prevalence, symptoms, endoscopic appearances and predictive factors of FE in children, regardless of immune status. Methods: A 2010-2020 retrospective case-control study was conducted on 1823 children presenting to Sydney Children’s Hospital for elective endoscopy with esophageal biopsy. Histopathology reports were reviewed to identify FE cases and determine prevalence rates. 32 patients with FE were age- and sex-matched (1:2) to 64 controls. Significant symptoms and risk factors of FE were identified via univariate and multivariate logistic regression analysis. Results ;The prevalence of FE in children was 1.76%. Common symptoms included dysphagia (25%), heartburn (25%), poor oral intake (21.9%), vomiting (18.8%), cough (15.6%), nausea (12.5%) and weight-loss (9.4%). No significant differences in symptoms were found between cases and controls. On endoscopy, although white plaques were associated with FE (p<0.001), visually-normal findings were reported in 28.1% of cases. Topical swallowed corticosteroids were a significant independent risk factor for FE (adjusted odds ratio [aOR]=10.740, 95% confidence interval [CI]: 1.213-95.101, p=0.033). Conclusions: The prevalence of FE in this pediatric cohort reflects rates amongst immunocompetent adults. Given that many of these children presented with a wide range of gastrointestinal symptoms, esophageal biopsy is required to accurately diagnose FE. Pediatricians should consider the risk of FE when prescribing topical swallowed corticosteroids.

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Section: Topical Swallowed Corticosteroidscontrasting

confidence: 65%

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Correia,

Weber,

Krishnan

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Candida can become pathogenic when the local environment, or milieu, changes and proliferation and invasion of the esophageal epithelium occurs (17). This has classically been attributed to reduced host immunity (neutropoenia (18), HIV (19), corticosteroids (20,21), chemotherapy (22)), abnormal esophageal motility (achalasia, esophageal atresia ( 23)) (19,24) but recently also due to dysbiosis and changing gastric pH with antibiotics and PPI therapy being associated with increased risk (25,26) (Table 1). This is particularly relevant to the pediatric patient given to the high incidence of antibiotic prescribing for children due to a high burden of respiratory infections (27) and the increasing prescription of PPIs (28).…”

Section: Candidamentioning

confidence: 99%

“…Endoscopic examination of the esophagus with histological examination of biopsies is the most sensitive and specific method of diagnosing esophageal candidiasis. Macroscopically, white plaques that cannot be washed away and a friable esophageal mucosa are seen; however, some cases of esophageal candidiasis have normal endoscopic appearances (2,20). Esophageal brushings can be collected for cytological evaluation of the causative organism (4,8), yet this does not differentiate fungal invasion from contamination or colonization (33).…”

Section: The Esophageal Microbiome and Potential Modifiable Risk Fact...mentioning

confidence: 99%

Infectious Esophagitis in Children

O’Donnell

Krishnan

2022

J. pediatr. gastroenterol. nutr.

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Infectious esophagitis is the third most common cause of esophagitis after gastroesophageal reflux disease and eosinophilic esophagitis (EoE) and should always be considered in the differential of patients with dysphagia and odynophagia. The most common organisms causing disease are candida, Herpes simplex virus (HSV) and cytomegalovirus (CMV). It is well recognized that an impaired local or systemic immune system is a risk factor for disease; however, esophageal dysmotility and disruptions in esophageal homeostasis and the esophageal milieu are likely to represent additional risk factors in disease pathogenesis.

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Prevalence of Esophageal Candidiasis Induced by Inhaled Corticosteroids

Cited by 2 publications

References 0 publications

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Infectious Esophagitis in Children

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