Prevalence and Risk Factors of Esophageal Candidiasis in Healthy Individuals: A Single Center Experience in Korea

Abstract

PurposeEsophageal candidiasis (EC) is the most frequent opportunistic fungal infection in immunocompromised host. However, we have found EC in healthy individuals through esophagogastroduodenoscopy (EGD). The aim of this study was to determine the prevalence and risk factors for EC in healthy individuals.Materials and MethodsWe retrospectively reviewed the medical records of 281 patients who had been incidentally diagnosed with EC. We also conducted age and sex matched case control study to identify the risk factor for EC.ResultsThe prevalence of EC was 0.32% (281/88125). The most common coexisting EGD finding was reflux esophagitis (49/281, 17.4%). An antifungal agent was prescribed in about half of EC, 139 cases (49.5%). Follow-up EGD was undertaken in 83 cases (29.5%) and 20 cases of candidiasis was persistently found. Case control study revealed EC were more often found in user of antibiotics (p=0.015), corticosteroids (p=0.002) and herb medication (p=0.006) as well as heavy drinking (p<0.001).ConclusionThe prevalence of EC was 0.32% (281/88125) in Korea. Use of antibiotics, corticosteroids and herb as well as heavy drinking were significant risk factors for EC in healthy individuals.

The clinical course of asymptomatic esophageal candidiasis incidentally diagnosed in general health inspection

“…Malignancies, chronic obstructive pulmonary disease, diabetes mellitus, acid suppression treatment, antibiotics, corticosteroid and immunosuppressant are known risk factors for esophageal candidiasis [1,3,4,10,13]. However, in our study, these were not independent risk factors for AEC.…”

“…Firstly, the baseline characteristics of our subjects may have differed from that of the general public or the subjects for the national cancer screening program. In a prior study, the prevalence of esophageal candidiasis varied from 0.32 to 3.8% [10,12,13]. Our study showed that only 0.4% of all the examinees were diagnosed with esophageal candidiasis and most were AEC.…”

“…Nowadays periodic health examination of the general public is becoming more common, and sometimes asymptomatic esophageal candidiasis (AEC) is incidentally diagnosed on general health inspection. However, little is known about the clinical course and significance of AEC [13]. The treatment of esophageal candidiasis among people with a healthy immune system has generally depended on whether there is an esophagitis symptom; however, there is still a lack of evidence [3].…”

Esophageal Candidiasis in a Patient With Uncontrolled Diabetes Mellitus and Recurrent Abdominal Pain, Symptomatic Or Incidental? A Case Report and Brief Literature Review

“…However, it can be found in individuals with no HIV infection and no evidence of opportunistic infections to suggest immunodeficiency [2,3]. The prevalence of EC as observed by Choi et al (0.32%, 281/88,125) [4] is lower compared to data reported by Underwood et al (0.71%, 18/2,527) [5] and by Naito et al (1.17%, 41/3,501) [6]. Since the early 1980s, most studies of EC have involved HIV-infected patients.…”

“…The association of DM with EC is often described when it is poorly controlled [23,24]. Another retrospective study from Korea involving 281 HIV-negative patients with EC found that there was no underlying disease in 69.8% of patients, while DM (8.2%) and malignancy (7.8%) were the two most common concomitant diseases [4].…”