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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Prevalence and risk factors for Candida esophagitis among human immunodeficiency virus-negative individuals
Yan-Hua Chen, Tzu-Ming Jao, Yow-Ling Shiue, I-Jung Feng, Ping-I Hsu
Yan-Hua Chen, Department of Internal Medicine, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung 91245, Taiwan
Yan-Hua Chen, Yow-Ling Shiue, Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
Yan-Hua Chen, Department of Nursing, Meiho University, Pingtung 91202, Taiwan
Tzu-Ming Jao, Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
Tzu-Ming Jao, Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei 10617, Taiwan
Yow-Ling Shiue, I-Jung Feng, Institute for Precision Medicine, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
Ping-I Hsu, Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 709204, Taiwan
Author contributions: All authors helped to perform the research; Chen YH and Hsu PI designed the study and drafted the manuscript; Chen YH, Jao TM, Shiue YL and Feng IJ collected the data; Chen YH, Jao TM, Shiue YL and Feng IJ performed statistical analyses; Chen YH, Jao TM, Shiue YL, Feng IJ and Hsu PI revised the manuscript critically for important intellectual content. All authors have read and approved the final manuscript.
Supported by the In-Hospital Research Project Funding of Kaohsiung Veterans General Hospital, No. VGHKS108-042; and An Nan Hospital, China Medical University, No. ANHRF109-38.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (VGHKS18-CT10-11).
Informed consent statement: Patients were not required to give informed consent to the study as the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ping-I Hsu, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, No. 66 Sec. 2 Changhe Road, Annan District, Tainan 709204, Taiwan. williamhsup@yahoo.com.tw
Received: February 6, 2022
Peer-review started: February 6, 2022
First decision: May 29, 2022
Revised: June 18, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: October 26, 2022
BACKGROUND
Candida esophagitis (CE) is among the commonest esophageal infections and is known as an opportunistic fungal infection mostly affecting people living with the human immunodeficiency virus (HIV). However, some medical conditions might predispose HIV-negative individuals to esophageal candidiasis. The epidemiology and associated endoscopic findings of CE among people without HIV have rarely been reported.
AIM
To investigate the prevalence of CE among HIV-negative persons, and determine risk factors predicting CE.
METHODS
Between January 2015 and December 2018, all consecutive outpatients who underwent routine esophagogastroduodenoscopy as part of health check-ups at their own expense at the Health Check-up Center of the Kaohsiung Veterans General Hospital, Taiwan, were recruited in this study. Those with positive HIV serology results were excluded. Sociodemographic and clinical characteristics including age, gender, economic status, smoking history, alcohol consumption, tea and coffee consumption, underlying diseases, body fat percentage, body mass index, endoscopic findings, and Helicobacter pylori infection status were carefully reviewed. CE was confirmed by endoscopic biopsy and pathological assessment with hematoxylin and eosin and periodic acid-Schiff staining. To evaluate independent factors predicting the development of CE, we conducted a univariate analysis of clinical characteristics. The variables found to be significant via univariate analysis were subsequently included in a multivariable analysis of potential risk factors for CE development.
RESULTS
A total of 11802 participants were included in this study. Forty-seven (0.4%) were confirmed as having CE by pathological examination. Univariate analysis identified older age, the presence of chronic kidney disease, alcohol consumption, and steroid use (P = 0.023, < 0.001, 0.033, and 0.004, respectively) as significantly associated with CE. Multivariable analysis revealed older age [adjusted odds ratio (OR) = 1.027; 95%CI: 1.001-1.053; P = 0.045], chronic kidney disease (adjusted OR = 13.470; 95%CI: 4.574-39.673; P < 0.001), alcohol consumption (adjusted OR = 2.103; 95%CI: 1.151-3.844; P = 0.016), and steroid use (adjusted OR = 24.255; 95%CI: 5.343-110.115; P < 0.001) as independent risk factors for CE development. The presence of dysphagia was associated with severe CE (P = 0.021).
CONCLUSION
The prevalence of CE among HIV-negative persons was 0.4% in Taiwan. Independent risk factors for CE were older age, chronic kidney disease, alcohol consumption, and steroid use.
Core Tip: Candida esophagitis (CE) is not only an opportunistic fungal infection affecting people living with the human immunodeficiency virus (HIV) but has also been identified in HIV-negative individuals. The prevalence of CE in Taiwan has reached 0.4% in general population, higher than previous reports. Significant risk factors include older age, chronic kidney disease, alcohol consumption, and steroid use. It is among the etiologies causing dysphagia in the general population, and esophagogastroduodenoscopy combined with histopathological examination are essential for accurate diagnosis.
