A groundbreaking study published online in JAMA Network Open reveals a significant association between esophageal Candida infection and an increased risk of esophageal cancer in patients with achalasia. Conducted by Dr. Xiaopei Guo and his team at the Erasmus University Medical Center in Rotterdam, the Netherlands, the research analyzed data from 234 patients diagnosed with achalasia between January 1980 and May 2024. The study highlights the critical need for vigilant monitoring and surveillance in this patient population to ensure early detection of potential malignancies.
The median age at diagnosis for the study participants was 45 years, with an equal distribution between men and women. Over a median follow-up period of 13 years, researchers evaluated the prevalence of Candida infections and their correlation with esophageal cancer risk. Focusing on 207 patients who had at least two consecutive endoscopy follow-up visits, the study found that prior esophageal Candida infections were strongly linked to an increased risk of developing esophageal cancer.
The study reported an adjusted hazard ratio (aHR) of 8.24 for individuals with prior esophageal Candida infections, translating to an 8.2-fold increased risk of esophageal cancer. Additionally, older age at diagnosis and male sex were identified as independent risk factors, with aHRs of 1.06 and 3.34 respectively. During the follow-up period, esophageal cancer progression was observed in 10% of patients, with esophageal squamous cell carcinoma accounting for 79% of these cases.
Dr. Guo emphasized the importance of regular surveillance for patients diagnosed with esophageal Candida infection, noting the cumulative risk of approximately 20% for Candida infection by 30 years post-diagnosis.
"Findings from our study emphasize the necessity of improved reporting of esophageal candidiasis during the surveillance of achalasia, and patients diagnosed with esophageal Candida infection should be considered for regular surveillance endoscopy for early detection of EC [esophageal cancer],"
- Xiaopei Guo, MD
The study's findings underscore the necessity for healthcare providers to remain vigilant in monitoring achalasia patients, particularly those with a history of Candida infection. Given the significant increase in cancer risk associated with these factors, enhanced reporting and regular endoscopic surveillance could play a vital role in reducing the incidence and mortality of esophageal cancer in this vulnerable group.
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