Esophageal Candidiasis and Associated Risk Factors

Esophageal candidiasis (EC) is an opportunistic fungal infection of the oesophageal mucosa, most often caused by Candida albicans. It arises when local or systemic host defences are weakened or the balance of commensal flora is disrupted. Risk factors include immunosuppression (for example due to HIV, haematological malignancies or corticosteroid therapy), advanced age, diabetes mellitus, prolonged antibiotic courses and acid-suppressive treatments. Clinical features range from odynophagia and dysphagia to retrosternal discomfort, though many cases may be asymptomatic. Definitive diagnosis relies on endoscopic visualisation of adherent white plaques and underlying mucosal changes, with histopathological confirmation of yeast and pseudohyphal invasion. First-line therapy employs systemic azole antifungals, yet variable drug penetration and emerging resistance demand continual optimisation of treatment protocols. Identification and modification of predisposing factors—such as tapering unnecessary proton pump inhibitors or reviewing immunosuppressive regimens—can reduce incidence and prevent serious complications including ulceration, necrosis and systemic dissemination.

Research from Nature Portfolio

A comprehensive analysis of over 7,700 endoscopy patients in a community hospital setting has pinpointed key risk determinants for EC in non-immunocompromised individuals. Multivariate assessment showed that diabetes mellitus, chronic use of proton pump inhibitors and presence of atrophic gastritis each conferred a moderate increase in EC risk. The odds of developing severe EC were particularly elevated in patients with advanced gastric cancer or prior gastrectomy. Importantly, a combined burden of mucosal atrophy and prolonged acid suppression produced a synergistic effect on fungal invasion. These insights support targeted endoscopic surveillance and risk stratification among patients with specific gastrointestinal alterations.

Esophageal Candidiasis and Associated Risk Factors publication trend

The graph below shows the total number of articles in esophageal candidiasis and associated risk factors across all publications each year (not limited to Nature Index journals).

Technical terms

Esophageal candidiasis: Fungal infection of the oesophageal lining by Candida species, confirmed by endoscopic plaque visualisation and histological evidence of invasion.

Proton pump inhibitor (PPI): Drug class that inhibits the gastric H+/K+ ATPase, reducing acid secretion and potentially altering mucosal defence.

Atrophic gastritis: Chronic inflammatory condition of the stomach resulting in glandular atrophy and diminished acid production, facilitating fungal overgrowth.

Dysphagia: Difficulty swallowing, often signalling oesophageal pathology.

Odynophagia: Painful swallowing, indicative of mucosal ulceration or severe inflammation.

Corticosteroids: Immunosuppressive agents that dampen inflammation but increase susceptibility to opportunistic infections.

References

1. Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. Canadian Journal of Gastroenterology and Hepatology (2019).
2. Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients. PLOS ONE (2015).
3. Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients. Medicine (2015).
4. Risk factors for the development of esophageal candidiasis among patients in community hospital. Scientific Reports (2021).