Guo Xiaopei, Lam Suk Yee, Janmaat Vincent T, de Jonge Pieter Jan F, Hansen Bettina E, Leeuwenburgh Ivonne, Peppelenbosch Maikel P, Spaander Manon C W, Fuhler Gwenny M
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands.
JAMA Netw Open. 2025 Jan 2;8(1):e2454685. doi: 10.1001/jamanetworkopen.2024.54685.
Patients with achalasia face a higher risk of developing esophageal cancer (EC), but the surveillance strategies for these patients remain controversial due to the long disease duration and the lack of identified risk factors.
To investigate the prevalence of esophageal Candida infection among patients with achalasia and to assess the association of Candida infection with EC risk within this population.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients with achalasia diagnosed at or referred for treatment and monitoring to the Erasmus University Medical Center in Rotterdam, the Netherlands, between January 1, 1980, and May 31, 2024. Data analysis was conducted from August 1 to October 31, 2024.
Esophageal Candida infection.
The primary outcomes were the prevalence of esophageal Candida infection and its association with EC development among patients with achalasia. Associations were estimated using time-dependent Cox proportional hazards regression models with esophageal Candida infection as a time-varying covariate, adjusting for age at diagnosis and sex.
This study included 234 patients with achalasia (median [IQR] age at diagnosis, 45 [32-63] years; 117 [50%] male), with a median follow-up time of 13 (4-22) years. Esophageal Candida infection was identified in 29 patients (12%), while EC was observed in 24 patients (10%). Esophageal cancer risk analysis was performed for 207 patients with 2 or more consecutive endoscopy follow-up visits (median [IQR] age at diagnosis, 43 [32-60] years; 104 [50%] male). The median (IQR) follow-up time for this subgroup was 16 (9-26) years. Among these patients, esophageal Candida infection was independently associated with an increased risk of EC (adjusted hazard ratio [AHR], 8.24 [95% CI, 2.97-22.89]). Additionally, age at diagnosis (AHR, 1.06 [95% CI, 1.03-1.10]) and male sex (AHR, 3.34 [95% CI, 1.08-10.36]) were independently associated with EC risk.
This retrospective cohort study found that prior esophageal Candida infection, older age at diagnosis, and male sex were associated with increased risk of EC among patients with achalasia. These findings provide an important rationale for optimizing the monitoring of patients with achalasia.
贲门失弛缓症患者患食管癌（EC）的风险更高，但由于病程长且缺乏明确的风险因素，这些患者的监测策略仍存在争议。
调查贲门失弛缓症患者食管念珠菌感染的患病率，并评估该人群中念珠菌感染与食管癌风险的关联。
设计、设置和参与者：这项回顾性队列研究纳入了1980年1月1日至2024年5月31日期间在荷兰鹿特丹伊拉斯姆斯大学医学中心被诊断或转诊接受治疗及监测的贲门失弛缓症患者。数据分析于2024年8月1日至10月31日进行。
食管念珠菌感染。
主要结局是贲门失弛缓症患者食管念珠菌感染的患病率及其与食管癌发生的关联。使用以食管念珠菌感染作为时变协变量的时间依赖性Cox比例风险回归模型估计关联，并对诊断时的年龄和性别进行调整。
本研究纳入了234例贲门失弛缓症患者（诊断时的年龄中位数[四分位间距]为45[32 - 63]岁；117例[50%]为男性），中位随访时间为13（4 - 22）年。29例患者（12%）被确诊为食管念珠菌感染，24例患者（10%）观察到食管癌。对207例有2次或更多次连续内镜随访的患者进行了食管癌风险分析（诊断时的年龄中位数[四分位间距]为43[32 - 60]岁；104例[50%]为男性）。该亚组的中位（四分位间距）随访时间为16（9 - 26）年。在这些患者中，食管念珠菌感染与食管癌风险增加独立相关（调整后的风险比[AHR]为8.24[95%置信区间，2.97 - 22.89]）。此外，诊断时的年龄（AHR为1.06[95%置信区间，1.
