Proton Pump Inhibitors and Corticosteroids as Synergistic Risk Factors for Candida Esophagitis
Nihar Shah *
Department of Gastroenterology, St. Joseph’s Regional Medical Center, Paterson, New Jersey, USA and School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA.
Yana Cavanagh
Department of Medicine, St. Joseph’s Regional Medical Center, Paterson, New Jersey, USA.
Oleg Shulik
Department of Gastroenterology, St. Joseph’s Regional Medical Center, Paterson, New Jersey, USA and School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA and Department of Medicine, Trintas Regional Medical Center, Paterson, New Jersey, USA.
Pooja Patel
School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA and Department of Medicine, Trintas Regional Medical Center, Paterson, New Jersey, USA.
Vincent A. DeBari
School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA.
Walid Baddoura
Department of Gastroenterology, St. Joseph’s Regional Medical Center, Paterson, New Jersey, USA and School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Inhaled & systemic steroids are one of the well-documented risks factors for Candida esophagitis. However, the role of gastric acid suppression remains controversial.
Methods: We conducted a retrospective case-control study of 420 patients consisting of 84 cases of Candida esophagitis and 336 matched controls. Our cohort was gathered from subjects evaluated from 2001 to 2012. The diagnosis of Candida esophagitis was based on endoscopic and/or histological criteria.
Results: On univariate analysis, proton pump inhibitors were associated with higher risk (OR = 2.14; 95 % CI: 1.30 to 3.54); steroid use also increased the risk (OR = 3.55; 95% CI: 2.10 to 6.00). Furthermore, concurrent use of proton pump inhibitors & steroids substantially raised this risk (OR = 13.8; 95% CI 5.07 to 37.5), suggesting a synergistic effect. When adjusted for covariates (cancer, chemotherapy/radiation, antibiotic use, hypothyroidism, anemia, chronic liver disease & diabetes), anemia decreased the odds ratio for proton pump inhibitors to 1.67 (95% CI 1.02 to 2.75) and steroids to 1.69 (95% CI to 1.03 to 2.87). Hypothyroidism also substantially reduced the observed risk associated with steroid use. However, neither anemia nor hypothyroidism reduced the odds ratio for combined use of steroids and proton pump inhibitors.
Conclusions: Our data suggests that patients who have been treated with steroids or proton pump inhibitors are at an increased risk for developing Candida esophagitis. Our data also suggests that steroids and proton pump inhibitors act synergistically to greatly increase the likelihood of Candida esophagitis.
Keywords: Candida esophagitis, esophageal moniliasis, Candida albicans, proton pump inhibitor, gastric acid inhibitor