Treatment of Gastric Candidiasis in Patients with Gastric Ulcer Disease: Are Antifungal Agents Necessary?

Abstract

Background/Aims: The inadequacy of information on the treatment of gastric candidiasis with antifungal agents promoted us to evaluate patients with fungal infections who had gastric ulcers and assess the need for proton-pump inhibitors or antifungal agents. Methods: Sixteen patients were included in the study. The criterion for the diagnosis of candidiasis was finding yeast and hyphae in the tissue or an ulcer on histological sections of biopsy samples. Surface fungi were not considered infections. Results: In all cases with benign ulcers, follow-up endoscopy performed 6 weeks after proton-pump-inhibitor treatment revealed that the ulcer had improved without antifungal medication. However, in patients with malignant ulcers, surgical resection was necessary for a definitive cure. Two patients with lymphoma received combined chemotherapy and a proton-pump inhibitor, which improved their condition. Conclusions: The results of this study suggest that benign ulcers with candidiasis can be effectively treated by a proton-pump inhibitor without antifungal medication. However, surgical resection should be considered for malignant ulcers with candidiasis. (Gut and Liver 2009;3:31-34)

Gastric Adenocarcinoma with Superadded Candida Infection In A Chronic Alcoholic

“…[1] As candida is a common commensal organism, its mere presence in culture studies or guided cytological smears must not suggest its gastric pathogenicity. [3] The patients usually present with epigastric pain/tenderness, fever with chills, nausea/vomiting, abdominal mass. [2,3] These malignant cases with superadded candida have a mean age of 59.7 years and tend to increase with increasing age.…”

“…[3] The patients usually present with epigastric pain/tenderness, fever with chills, nausea/vomiting, abdominal mass. [2,3] These malignant cases with superadded candida have a mean age of 59.7 years and tend to increase with increasing age. [3] On gastric endoscopy, two types of lesions can be seen: thrush type with slough/exudates or ulcerative type with defined margins and a mean size of 66mm.…”

“…[2,3] These malignant cases with superadded candida have a mean age of 59.7 years and tend to increase with increasing age. [3] On gastric endoscopy, two types of lesions can be seen: thrush type with slough/exudates or ulcerative type with defined margins and a mean size of 66mm. [3] It helps in presuming a benign/malignant type of the gastric ulcer.…”

“…Its association with benign gastric ulcers is more commonly seen compared to malignant ulcers. [1][2][3] Although apart from diabetics, immunosuppressive patients like HIV positive cases, steroid usage, anti-cancer drugs, systemic diseases, organ and marrow transplantation, chronic alcoholism and smoking are the risk factors, gastric candidiasis have been reported in immunocompetent healthy cases too. [4] Our rare case enlightens the definite diagnosis of gastric adenocarcinoma with superadded candida infection in a non-diabetic, chronic alcoholic with altered immune status.…”

A rare co-existence of helicobacter pylori, candida albicans and candida keyfr in a giant gastric ulcer

“…The treatment of candidal ulcer includes two alternative medications, including acid suppressants and anti-fungal therapy. The duration of treatment is usually 6-8 weeks with acid suppressants and 2-3 weeks with antifungal drugs (4,5). Although fluconazole has the potential for hepatotoxicity, which requires periodic blood work follow-up, it is usually reversible on discontinuation of therapy.…”