Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2025; 31(7): 101104
Published online Feb 21, 2025. doi: 10.3748/wjg.v31.i7.101104
Internal transcribed spacer sequencing to explore the intrinsic composition of fungal communities in fungal esophagitis
Yi-Kang Song, Lin Zheng, Ai-Xin Liu, Jun-Ji Ma
Yi-Kang Song, Lin Zheng, Ai-Xin Liu, Jun-Ji Ma, Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang050000, Hebei Province, China
Co-first authors: Yi-Kang Song and Lin Zheng.
Author contributions: Song YK and Zheng L contribute equally to this study as co-first authors; Song YK contributed to conceptualization and wrote the original draft; Zheng L and Liu AX contributed to manuscript review and edit; Ma JJ was responsible for directing manuscript writing and final proofreading and polishing; all authors have read and approved the final version of the manuscript.
Supported by Hebei Province 2023 Annual Medical Science Research Project, No. 20230597; and Hebei Province 2024 Annual Medical Applicable Technology Tracking Project, No. GZ2024017.
Institutional review board statement: This study was reviewed and approved by the Research Ethics Committee of the second hospital of Hebei Medical University (Approval No. 2023-R-112).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request, provided that the data can be made available in accordance with applicable data protection and privacy regulations.
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: Jun-Ji Ma, MD, PhD, Associate Professor, Chief Physician, Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, No. 215 Heping West Road, Shijiazhuang 050000, Hebei Province, China. majunji@hebmu.edu.cn
Received: September 23, 2024
Revised: December 9, 2024
Accepted: December 30, 2024
Published online: February 21, 2025
Processing time: 118 Days and 20.3 Hours
Abstract
BACKGROUND

Fungal esophagitis (FE) is caused by fungal invasion of the esophageal mucosa. Under endoscopy, the esophageal mucosa shows edema, congestion, erosion, and ulceration, and bleeds easily when touched, and the surface of the mucosa is covered with small white spots like "bean curd residue". Clinical cases showing typical FE under endoscopic imaging but negative esophageal mucosal brush (referred to as suspected FE) have increased the difficulty and challenge of clinical diagnosis and treatment. At present, the esophageal fungal flora of suspected case has not been thoroughly studied.

AIM

To characterize the fungal flora in FE, suspected FE, and the esophageal normal controls (NCs), and to identify marker species to improve detection of FE.

METHODS

This was a case-control study. A total of 19 patients with FE, 16 with suspected FE, and 10 NCs were selected by endoscopy. The esophageal cell brush samples of each group were sequenced by internal transcribed spacer (ITS) 1 and analyzed by bioinformatics.

RESULTS

In FE and suspected FE patients, species richness, species diversity and species evenness, as measured by the Chao1 index, Shannon index and Pielou index, were lower than in the NCs, and the comparison between the FE and NCs was the most significant (P < 0.05). Compared with the NCs, the relative abundance of Candida in FE and suspected FE patients was significantly increased (P < 0.001), while the relative abundance of Yarrowia was significantly decreased (P < 0.05). Moreover, Yarrowia abundance in the FE group was significantly lower than in the NCs and suspected FE groups (P < 0.001). The area under the curve for Candida in FE and suspected FE patients was 99.5% (P < 0.05) and 81.3% (P < 0.05), respectively. Finally, compared with FE patients, the relative abundance of Ascomycota and Candida in the esophageal flora of suspected FE patients was decreased, while the relative abundance of Yarrowia, Thermomyces and Pichia was increased.

CONCLUSION

ITS showed that composition of the fungal community was similar in the FE and suspected FE groups. ITS can be used as an auxiliary diagnostic method for FE and provide a theoretical basis for follow-up diagnosis and treatment.

Keywords: Fungal microbiota; Esophagitis; Candida; Yarrowia; Biomarker

Core Tip: Suspected fungal esophagitis (FE) is difficult to diagnose clinically and makes subsequent treatment difficult. In this paper, internal transcribed spacer sequencing was used to investigate the characteristics of fungal microflora in FE, suspected FE and the esophageal normal controls, and to search for its marker strains, to provide evidence for the diagnosis and treatment of suspected FE.