Esophageal candida infection associated with increased esophageal cancer risk in patients with achalasia

1. Among 234 patients with achalasia, esophageal candidiasis was identified in 12%.

2. Among patients with achalasia, prior esophageal candidiasis, older age at diagnosis and male sex were associated with an increased risk of developing esophageal cancer (EC).

Evidence Rating Level: 2 (Good)

Patients with achalasia are at higher risk of developing EC. However, the specific pathophysiological mechanism underlying this phenomenon has not been well established. A recent hypothesis posits that food stasis promotes the overgrowth of microorganisms like bacteria and some fungal species which can cause chronic inflammation leading to dysplasia of the esophageal mucosa. This retrospective cohort study therefore sought to investigate the prevalence of esophageal Candida infection in patients with achalasia and to evaluate its association with the development of EC. 234 patients (median [IQR] age at diagnosis, 45 [32-63] years; 50% female) with achalasia at the Erasmus University Medical Centre between January 1980 and May 2024 were included in the study. During follow-up, 29 patients (12%) experienced at least 1 episode of esophageal candidiasis while 24 patients (10%) experienced EC. Using Cox proportional hazards regression models with esophageal candidiasis as a time-varying covariate, Candida infection was associated with an increased risk of developing EC (crude univariate HR, 10.44 [95% CI, 3.78-28.83]; P < .001). Overall, this study found that the prevalence of esophageal Candida infection in patients with achalasia was 12%, and that esophageal candidiasis was associated with a higher risk of developing EC.

Click to read the study in JAMA Network Open

Image: PD

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