Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2023; 15(6): 480-490
Published online Jun 16, 2023. doi: 10.4253/wjge.v15.i6.480
Prevalence and clinical risk factors for esophageal candidiasis in non-human immunodeficiency virus patients: A multicenter retrospective case-control study
Alexandra V Kimchy, Akram I Ahmad, Lindsey Tully, Connor Lester, Kavya Sanghavi, Joseph J Jennings
Alexandra V Kimchy, Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
Akram I Ahmad, Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20007, United States
Lindsey Tully, Connor Lester, Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC 20007, United States
Kavya Sanghavi, Department of Biostatistics and Biomedical Informatics, MedStar Research Institute, Hyattsville, MD 20781, United States
Joseph J Jennings, Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
Author contributions: All authors contributed to the study conception and design; material preparation, data collection, and analysis were performed by all authors listed; the first draft of the manuscript was written by Alexandra V Kimchy and all authors commented on previous versions of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the MedStar Health-Georgetown University Institutional Review Board.
Informed consent statement: The study was exempt from informed consent based on the MedStar Health-Georgetown University Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Datasets are available from the corresponding author at Alexandra.v.kimchy@medstar.net.
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: Alexandra V Kimchy, DO, Doctor, Department of Internal Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, PHC 6, Washington, DC 20007, United States. alexandra.v.kimchy@medstar.net
Received: April 17, 2023
Peer-review started: April 17, 2023
First decision: May 19, 2023
Revised: May 20, 2023
Accepted: May 31, 2023
Article in press: May 31, 2023
Published online: June 16, 2023
Processing time: 57 Days and 10.8 Hours
ARTICLE HIGHLIGHTS
Research background

Infectious esophagitis is well known to occur in immunocompromised patients particularly those with human immunodeficiency virus with Candida being the most common pathogen isolated.

Research motivation

While esophageal candidiasis (EC) has most often been associated with human immunodeficiency virus (HIV), a recent study showed a decreasing prevalence of EC among patients with HIV and an increase in the prevalence of EC among patients without HIV. Although EC can develop in individuals without HIV, studies investigating clinical risk factors for infection in this patient population have been far less to date. We designed this study to determine the prevalence, clinical manifestations, and risk factors for EC in a non-HIV patient population.

Research objectives

The aim of this study was to determine the prevalence of EC in patients without HIV and identify common clinical presentations and risk factors for EC in this patient population.

Research methods

This retrospective case-control study encompassed inpatient and outpatient encounters from 5 hospitals located in the District of Columbia and Maryland regions of the United States. Cases of EC were identified among patients who had endoscopic biopsies of the esophagus and the presence of EC on cytology and/or histopathology. Patients with HIV were excluded. Multivariable logistic regression was used to identify independent risk factors for EC, after adjusting for potential confounding factors.

Research results

This study determined the prevalence of EC in the non-HIV patient population to be approximately 9% from 2015 through 2020. We found that patients with EC presented most often with non-specific gastrointestinal complaints while odynophagia and chest pain manifested in only a small percentage of patients. Less than half of patients with EC had white/yellow plaques present on endoscopy. Prior organ transplant, proton pump inhibitors, and corticosteroids were identified as independent risk factors for EC.

Research conclusions

The prevalence of EC in our study was higher than expected based upon rates reported in prior studies. Classic symptoms of infectious esophagitis are less common in patients without HIV. Clinicians may consider esophageal biopsy for histopathologic diagnosis in patients with risk factors for EC presenting with atypical symptoms and/or absence of white plaques on endoscopy. Significant risk factors for infection in our study were a history of organ transplant, proton pump inhibitor, or corticosteroids use.

Research perspectives

Further studies are needed to evaluate for an increasing prevalence of EC and risk factors for infection in the non-HIV patient population.