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

Lee, Sang Pyo; Sung, In‐Kyung; Kim, Jeong Hwan; Lee, Sun-Young; Park, Hyung Seok; Shim, Chan Sup

doi:10.3109/00365521.2015.1057519

Cited by 11 publications

(7 citation statements)

References 16 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%

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The diagnosis of clinically significant oesophageal Candida infections: 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%

“…Lee et al . evaluated 141 asymptomatic patients with Candida oesophagitis, and found that 81% showed resolution of oesophageal inflammation on follow‐up endoscopy, even though most were not treated with antifungal therapy 28 . Hoversten et al .…”

Section: Discussionmentioning

confidence: 99%

The diagnosis of clinically significant oesophageal Candida infections: a reappraisal of clinicopathological findings

et al. 2020

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“…These findings support the notion that esophageal candidiasis can be an incidental and perhaps commensal finding capable of resolution without antifungal treatment. 6 As a result, avoiding antifungal treatment in a select subset of patients with Candida present in the esophagus may be justified.…”

Section: Discussionmentioning

confidence: 99%

Course of Esophageal Candidiasis and Outcomes of Patients at a Single Center

Hoversten

Otaki

Katzka

2019

Clinical Gastroenterology and Hepatology

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C andida infection in the gastrointestinal tract is most studied in immunocompromised patients. Patients without systemic immunodeficiency, however, may have esophageal candidiasis associated with antibiotic or steroid medication use, alcoholic consumption, diabetes mellitus, and esophageal stasis disorders such achalasia or scleroderma esophagus. 1-5 This population has not been well studied. We aim to describe demographics, risk factors, and relevant clinical outcomes for patients with Candida esophagitis with an emphasis in systemically immunocompetent patients. Methods The Mayo Clinic pathology database was queried for all patients with endoscopically suspected esophageal candidiasis confirmed by biopsy or brushing from

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“…Previous studies have mainly addressed risk factors for development of EC in patients without a human immunodeficiency virus infection and were limited by relatively small series and a heterogeneous study population. 8 – 10 Recently, Lee et al 15 reported the risk factors for AEC and a good prognosis of AEC without antifungal treatment. In contrast, this current study evaluated the clinical impact of antifungal treatment in immunocompetent individuals with AEC and investigated the prognostic factors associated with recurrent or persistent EC.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Son

et al. 2015

Medicine

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Although esophageal candidiasis (EC) is an opportunistic infection, asymptomatic EC (AEC) is occasionally encountered in otherwise healthy individuals. This study evaluates the impact of antifungal treatment in immunocompetent individuals with AEC and investigates risk factors for persistent or recurrent EC. The authors identified patients with biopsy-proven AEC from the database of individuals receiving screening endoscopy (n = 99,255). After excluding patients receiving immunosuppressive therapy, being positive for human immunodeficiency virus, receiving no follow-up endoscopy, or having no antifungal treatment data, a total of 142 patients were divided into remission and nonremission groups. Remission was defined when EC was not detectable on follow-up endoscopy. On baseline comparison, nonremission group was older (57.5 ± 10.3 versus 52.5 ± 10.5 years, P = 0.017) and more likely to have cardiovascular disease (12.9% versus 1.8%, P = 0.021) and history of pulmonary tuberculosis (PTB) (22.6% versus 4.5%, P = 0.004) and exhibited a lower triglyceride level (101.4 ± 37.4 versus 122.6 ± 79.6 mg/dL, P = 0.039) than remission group, whereas grade of EC and concomitant endoscopic findings did not differ between 2 groups. Antifungal treatment was also similarly performed between 2 groups. Multivariate analysis revealed that history of PTB is independently associated with nonremission (odds ratio 4.495, 95% confidence interval 1.023–19.762, P = 0.047). No patients demonstrated EC-related complications during a mean follow-up of 28.0 ± 12.0 months. In conclusion, our results suggested that antifungal treatment is not required for immunocompetent individuals with AEC and past history of PTB is an independent predictor for persistent or recurrent EC.

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

Abstract: AEC is rare and old age is the only risk factor. AEC does not require medical care because it is a self-limited disease.

Cited by 11 publications

References 16 publications

The diagnosis of clinically significant oesophageal Candida infections: a reappraisal of clinicopathological findings

The diagnosis of clinically significant oesophageal Candida infections: a reappraisal of clinicopathological findings

Course of Esophageal Candidiasis and Outcomes of Patients at a Single Center

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

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