Nassar Yousef, Eljabbour Tony, Lee Hwajeong, Batool Asra
Department of Medicine, Albany Medical Center, 43 New Scotland Ave., Albany, NY 12208, USA.
Department of Pathology, Albany Medical Center, 43 New Scotland Ave., Albany, NY 12208, USA.
Gastroenterology Res. 2018 Jun;11(3):195-199. doi: 10.14740/gr1019w. Epub 2018 May 31.
Candida esophagitis (CE) is a condition typically diagnosed in patients who are immunocompromised. Risk factors leading to the development of CE in immunocompetent patients have not been entirely elucidated. This study set out to identify risk factors associated with the development of CE in immunocompetent patients.
This study was a single-center retrospective chart review. Patients diagnosed with CE confirmed by endoscopic biopsy or brushings at our hospital between 2007 and 2017 were reviewed. The medical histories, endoscopy reports and pathology results were noted. Abdominal pain, heartburn, dysphagia and odynophagia were the common indications for endoscopy. A total of 241 patients were identified as having been diagnosed with CE by endoscopic brushing or biopsy. Of these patients, 161 were excluded due to the presence of immunocompromising and 80 patients were included who had no underlying immunocompromising conditions.
Eighty patients with CE satisfied the inclusion criteria. The mean age of patients at the time of diagnosis was 39.8 years old (95% CI: 34.9 - 44.7). The incidences in men and women were similar in this study (49% women and 51% men). Of these patients, 56 (70%) (95% CI: 59-80%; P < 0.005) were taking proton pump inhibitors (PPIs). Fifteen patients (19%) had a previous upper endoscopy with evidence of reflux esophagitis, and they were all treated with PPIs and subsequently found to have CE on repeat upper endoscopy with a mean of 21.6 months of PPI treatment. There were 16 (20%) patients without any attributable risk factor and were completely healthy.
CE is an opportunistic infection typically seen in immunocompromised. We report incidence of CE in immunocompetent patients. In our cohort of immunocompetent patients, PPI use was the most common risk factor associated with the development of CE. This could be related to hypochlorhydria resulting from PPI use. However, the cause remains unclear in some patients.
念珠菌食管炎（CE）通常在免疫功能低下的患者中被诊断出来。导致免疫功能正常患者发生CE的危险因素尚未完全阐明。本研究旨在确定免疫功能正常患者发生CE的相关危险因素。
本研究为单中心回顾性病历审查。对2007年至2017年期间在我院经内镜活检或刷检确诊为CE的患者进行了回顾。记录病史、内镜检查报告和病理结果。腹痛、烧心、吞咽困难和吞咽痛是内镜检查的常见指征。共有241例患者经内镜刷检或活检确诊为CE。其中，161例因存在免疫功能低下而被排除，80例无潜在免疫功能低下情况的患者被纳入研究。
80例CE患者符合纳入标准。诊断时患者的平均年龄为39.8岁（95%CI：34.9 - 44.7）。本研究中男性和女性的发病率相似（女性49%，男性51%）。这些患者中，56例（70%）（95%CI：59 - 80%；P < 0.005）正在服用质子泵抑制剂（PPI）。15例（19%）患者既往上消化道内镜检查有反流性食管炎证据，他们均接受PPI治疗，随后在平均PPI治疗21.6个月后的重复上消化道内镜检查中发现患有CE。有16例（20%）患者没有任何可归因的危险因素且完全健康。
CE是一种机会性感染，通常见于免疫功能低下者。我们报告了免疫功能正常患者中CE的发病率。在我们的免疫功能正常患者队列中，使用PPI是与CE发生相关的最常见危险因素。这可能与使用PPI导致的胃酸过少有关。然而，在一些患者中病因仍不清楚。
