Antifungal Treatment is Not Required for Immunocompetent Individuals With Asymptomatic Esophageal Candidiasis

Ye, Min; Kim, Eun; Son, Hee Jung; Kim, Jae J.; Rhee, Poong–Lyul

doi:10.1097/md.0000000000001969

Cited by 9 publications

(3 citation statements)

References 22 publications

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“…The mainstay of therapy for Candida oesophagitis is oral fluconazole, with resolution rates of >90% in treated patients 10,21–26 . However, emerging data suggest that not all patients require therapeutic intervention 27,28 . Lee et al .…”

Section: Discussionmentioning

confidence: 99%

The diagnosis of clinically significant oesophagealCandidainfections: a reappraisal of clinicopathological findings

et al. 2020

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Aims Distinguishing true oesophageal Candida infections from oral contaminants is a common diagnostic issue. Historically, histological features believed to indicate true infection included epithelial invasion by pseudohyphae and intraepithelial neutrophils. Whether or not these features correlate with endoscopic lesions, symptoms and response to therapy has never been tested in a large cohort. The aim of this study was to determine whether specific histological features correlate with clinical and endoscopic findings when Candida is found in oesophageal biopsies. Methods and results We reviewed 271 biopsies in which Candida was detected. Cases were evaluated for the presence of desquamated epithelial cells, location/type of fungal forms, neutrophils, and ulceration. Medical records were reviewed for clinical history, endoscopic lesions, and response to antifungal therapy. Statistical analysis was used to determine whether any histological features significantly correlated with clinical variables. There were 120 males and 151 females with a mean age of 42 years. Fifty‐nine per cent had symptoms referable to the oesophagus, particularly dysphagia (36%). Most (73%) patients had abnormal endoscopic findings, with plaques, ulcers, or macroscopic evidence of oesophagitis. Seventy‐one per cent of patients with documented antifungal therapy showed symptomatic improvement. Overall, there was no statistically significant correlation between any histological feature and presenting symptoms, endoscopic findings, or response to therapy. Importantly, the lack of pseudohyphae, demonstrable invasion of intact epithelium or neutrophilic infiltrates did not exclude clinically significant infection. Conclusions We conclude that detection of Candida in oesophageal biopsies is always potentially clinically significant. Treatment decisions should be made on the basis of an integration of clinical, endoscopic and histological findings.

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Section: Discussionmentioning

confidence: 99%

The diagnosis of clinically significant oesophagealCandidainfections: a reappraisal of clinicopathological findings

et al. 2020

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“…7,13,41,42 On the other hand, asymptomatic candida colonization will also be found in a relevant portion of otherwise healthy individuals if only one looks close enough, and the variance between different populations is high. [43][44][45] As of today, the significance of candida infection in DEIPD remains unclear. Another conceivable mechanism of inflammation in DEIPD would be a kind of food intolerance or allergy.…”

Section: Pathogenesismentioning

confidence: 99%

“…What can be deducted from case reports and small series is that the incidence and prevalence of candidiasis are comparatively high in DEIPD patients and that individuals who are negative for candida in one presentation can be positive in another 7,13,41,42 . On the other hand, asymptomatic candida colonization will also be found in a relevant portion of otherwise healthy individuals if only one looks close enough, and the variance between different populations is high 43–45 . As of today, the significance of candida infection in DEIPD remains unclear.…”

Section: Pathogenesismentioning

confidence: 99%

Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis

Hentschel

2022

JGH Open

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Diffuse esophageal intramural pseudo‐diverticulosis (DEIPD) is a chronic fibrosing inflammation of the esophagus of unknown origin. Its name derives from the characteristic pseudo‐diverticula formed by dilated ducts of submucosal glands. With an assumed prevalence of approximately 5–50/100 000, DEIPD is more frequent than previously estimated. It preferentially affects men between 50 and 70 years of age with a history of alcohol and tobacco abuse. Key symptoms are chronic dysphagia and food impactions. Typical endoscopic findings are multiple small, longitudinally aligned pseudo‐diverticle openings and trachealization of the esophagus. Additionally, the usually gray mucosa may show a fine‐grained pattern of very small red dots that merge into a pink tint, called “faux uni pattern.” Once established, clinical symptoms and endoscopic changes persist throughout life. Although there is no known causal therapy, complications like bolus impactions, candida infections, or reflux can and should be treated.

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Seltene Entzündungen des Ösophagus

Hentschel

Lüth

2019

Internist

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Antifungal Treatment is Not Required for Immunocompetent Individuals With Asymptomatic Esophageal Candidiasis

Cited by 9 publications

References 22 publications

The diagnosis of clinically significant oesophagealCandidainfections: a reappraisal of clinicopathological findings

The diagnosis of clinically significant oesophagealCandidainfections: a reappraisal of clinicopathological findings

Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis

Seltene Entzündungen des Ösophagus

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