The clinical course of asymptomatic esophageal candidiasis incidentally diagnosed in general health inspection

Abstract

Objective. Esophageal candidiasis mostly occurs in the immunocompromised host. However, it may also affect healthy people and is frequently asymptomatic. The clinical significance of asymptomatic esophageal candidiasis (AEC) is still unclear. The aims of the study were to investigate the prevalence of AEC during health inspection and to identify its predisposing factors and clinical significance. Materials and methods. A total of 49,497 subjects who underwent a health inspection that included upper endoscopy were enrolled. We retrospectively reviewed the subject’s self-reporting questionnaires, medical records and endoscopic findings. We considered “long-term” follow-up to be >6 months with at least one more follow-up endoscopy. Results. One hundred and seventy (0.4%) subjects were endoscopically diagnosed as esophageal candidiasis and 141 subjects were AEC. Multivariate analysis revealed that old age (≥60 years) was an independent risk factor for AEC (OR, 1.862, p = 0.005). The number of subjects with long-term follow-up was 79 (195.3 person-years). Among these, AEC of 64 subjects (81.0%) had disappeared on the follow-up endoscopy and was not recurrent. The other 15 subjects had AEC diagnosed more than once on the follow-up endoscopy, and 5 of them were spontaneously healed during the follow-up period. The remaining 10 subjects whose candidiasis was sustained up to the last endoscopy did not complain of symptoms during the follow-up period, and their endoscopic findings did not worsen. Conclusions. AEC is rare and old age is the only risk factor. AEC does not require medical care because it is a self-limited disease.

Key Words:

• candida esophagitis
• esophageal candidiasis
• infectious esophagitis

Acknowledegments

Contributors: S. P. Lee: Study concept, design, analysis of data and drafting of the manuscript. I.-K. Sung: Study concept, interpretation of data and drafting of the manuscript. J. H. Kim, S.-Y. Lee, H. S. Park, C. S. Shim: Acquisition of data and critical revision of the manuscript. Funding: There are no funders to report for this submission. Ethics approval: The study protocol was approved by the Institutional Review Board of Konkuk University Medical Center (KUH1010601). Provenance and peer review: Not commissioned. Clinical trial registration number: KCT0001230. All authors disclose no financial relationships relevant to this publication.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.