Kimchy Alexandra V, Ahmad Akram I, Tully Lindsey, Lester Connor, Sanghavi Kavya, Jennings Joseph J
Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20007, United States.
World J Gastrointest Endosc. 2023 Jun 16;15(6):480-490. doi: 10.4253/wjge.v15.i6.480.
Although esophageal candidiasis (EC) may manifest in immunocompetent individuals, there is a lack of consensus in the current literature about predisposing conditions that increase the risk of infection.
To determine the prevalence of EC in patients without human immunodeficiency virus (HIV) and identify risk factors for infection.
We retrospectively reviewed inpatient and outpatient encounters from 5 regional hospitals within the United States (US) from 2015 to 2020. International Classification of Diseases, Ninth and Tenth Revisions were used to identify patients with endoscopic biopsies of the esophagus and EC. Patients with HIV were excluded. Adults with EC were compared to age, gender, and encounter-matched controls without EC. Patient demographics, symptoms, diagnoses, medications, and laboratory data were obtained from chart extraction. Differences in medians for continuous variables were compared using the Kruskal-Wallis test and categorical variables using chi-square analyses. Multivariable logistic regression was used to identify independent risk factors for EC, after adjusting for potential confounding factors.
Of the 1969 patients who had endoscopic biopsies of the esophagus performed from 2015 to 2020, 295 patients had the diagnosis of EC. 177 of 1969 patients (8.99%) had pathology confirming the diagnosis of EC and were included in the study for data collection and further analysis. In comparison to controls, patients with EC had significantly higher rates of gastroesophageal reflux disease (40.10% 27.50%; = 0.006), prior organ transplant (10.70% 2%; < 0.001), immunosuppressive medication (18.10% 8.10%; = 0.002), proton pump inhibitor (48% 30%; < 0.001), corticosteroid (35% 17%; < 0.001), Tylenol (25.40% 16.20%; = 0.019), and aspirin use (39% 27.50%; = 0.013). On multivariable logistic regression analysis, patients with a prior organ transplant had increased odds of EC (OR = 5.81; = 0.009), as did patients taking a proton pump inhibitor (OR = 1.66; = 0.03) or corticosteroids (OR = 2.05; = 0.007). Patients with gastroesophageal reflux disease or medication use, including immunosuppressive medications, Tylenol, and aspirin, did not have a significantly increased odds of EC.
Prevalence of EC in non-HIV patients was approximately 9% in the US from 2015-2020. Prior organ transplant, proton pump inhibitors, and corticosteroids were identified as independent risk factors for EC.
尽管食管念珠菌病（EC）可能在免疫功能正常的个体中出现，但目前文献中对于增加感染风险的易感因素缺乏共识。
确定无人类免疫缺陷病毒（HIV）患者中EC的患病率，并确定感染的危险因素。
我们回顾性分析了2015年至2020年美国5家地区医院的住院和门诊病例。使用国际疾病分类第九版和第十版来识别接受食管内镜活检并诊断为EC的患者。排除HIV患者。将患有EC的成年人与年龄、性别匹配且未患EC的对照者进行比较。从病历提取中获取患者的人口统计学信息、症状、诊断、用药情况和实验室数据。连续变量中位数的差异采用Kruskal-Wallis检验进行比较，分类变量采用卡方分析。在调整潜在混杂因素后，使用多变量逻辑回归来识别EC的独立危险因素。
在2015年至2020年接受食管内镜活检的1969例患者中，295例被诊断为EC。1969例患者中有177例（8.99%）经病理确诊为EC，并纳入本研究进行数据收集和进一步分析。与对照组相比，EC患者的胃食管反流病发生率显著更高（40.10%对27.50%；P = 0.006），既往有器官移植史（10.70%对2%；P < 0.001），使用免疫抑制药物（18.10%对8.10%；P = 0.002），质子泵抑制剂（48%对30%；P < 0.001），皮质类固醇（35%对17%；P < 0.001），对乙酰氨基酚（25.40%对16.20%；P = 0.019），以及使用阿司匹林（39%对27.50%；P = 0.013）。在多变量逻辑回归分析中，既往有器官移植史的患者发生EC的几率增加（OR = 5.81；P = 0.009），服用质子泵抑制剂的患者（OR = 1.66；P = 0.03）或皮质类固醇的患者（OR = 2.05；P = 0.007）也是如此。患有胃食管反流病或使用药物（包括免疫抑制药物、对乙酰氨基酚和阿司匹林）的患者发生EC的几率没有显著增加。
2015 - 2020年美国非HIV患者中EC的患病率约为9%。既往器官移植、质子泵抑制剂和皮质类固醇被确定为EC的独立危险因素。
