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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
ARTICLE HIGHLIGHTS
Research background
Candida esophagitis (CE) is an opportunistic esophageal fungal infection mostly affecting human immunodeficiency virus (HIV)-positive people. However, some HIV-negative individuals are prone to esophageal candidiasis under certain medical conditions.
Research motivation
The definite diagnosis of CE relies on both endoscopic and histopathological findings. However, the epidemiology of CE diagnosed with strict histopathological confirmation among the general population without HIV in Taiwan has rarely been reported.
Research objectives
To update the prevalence of CE among HIV-negative persons, and identify independent risk factors predicting CE in Taiwan.
Research methods
HIV-negative outpatients who underwent routine esophagogastroduodenoscopy at the Health Check-up Center of the Kaohsiung Veterans General Hospital, Taiwan, between January 2015 and December 2018 were recruited. Sociodemographic status, clinical characteristics, and endoscopic findings were carefully reviewed. CE was confirmed by endoscopic biopsy and pathological assessment. A univariate analysis of clinical characteristics was conducted to evaluate independent factors predicting CE. Significant variables found via univariate analysis were subsequently included in a multivariable analysis of potential risk factors for CE development.
Research results
A total of 11802 participants were included in this study. The prevalence of CE confirmed by pathological examination was 0.4%. 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.
Research conclusions
The prevalence of CE among HIV-negative population in Taiwan has reached 0.4%. Older age, chronic kidney disease, alcohol consumption, and steroid use were independent risk factors for CE.
Research perspectives
CE is not an uncommon esophageal disease among the HIV-negative population in Taiwan. Chronic kidney disease was an independent risk factor for the development of CE, which was a unique finding in our study.
