Retrospective Analysis Of Epidemiological And Clinical Features Of Esophageal Candidiasis

Background Esophageal candidiasis(EC)is an ulcerative pseudomembranous esophagitis caused by candida invading the esophageal mucosa.Over the past decades,the understanding of candidiasis has generally been that it was caused by individuals compromised physical immunity.However,in current clinical practice,people with good immune systems are increasingly being diagnosed with EC.Candidiasis,especially invasive candidiasis,is often difficult to diagnose at early stage,leading to delay in treatment and affecting patient outcomes.At present,only the cultivation of candida from clinical specimens can be used as the basis for the diagnosis of candidiasis.Thus,the medical profession diagnoses according to the pretreatment method with a doctor's personal experience.It certainly has value in clinical practice,but it really leads to the unreasonable overuse of antifungal drugs.What's more,it is rather inconducive to young doctors to master neither the epidemiological characteristics nor the clinical features of the disease and be applied to guide the clinical decision in clinical practice.Therefore,mastering the epidemiological characteristics and clinical features of Esophageal Candidiasis is one of the important topics for young doctors to recognize Esophageal Candidiasis at the early stage.Objective Through the retrospective analysis of the cases in a certain population during a consecutive period,it preliminarily showed the related factors of epidemiological characteristics and incidence rate of EC.Through retrospective analysis of the confirmed cases of EC,clinical symptoms and concomitant diseases related to EC were screened out.Methods Based on Observational Study,118,573 clinical cases during December 2014 to December2018,were reviewed retrospectively,all of which underwent upper gastrointestinal endoscopy.All the prospective clinical data were collected from the Digestive Endoscopy Center of the Second Affiliated Hospital,Zhejiang University,School of Medicine.The data were processed by SPSS Statistics 26.0 Crack.Data was expressed as(Mean ±Standard Deviation).T-Test was used to analyze the measurement data that conformed to the normal distribution,while Mann-Whitney U Test to the measurement data that did not conform to the normal distribution.P < 0.05 was statistically significant.Chi-Square Test was used to compare the incidence rates of EC in different age groups and gender.In addition,rates of risk factors,clinical symptoms and concomitant diseases were compared among the diagnosed population.Results From December 2014 to December 2018,a total of 18,573 cases of EGD met the inclusion criteria,of which 377 cases(0.32%)were diagnosed as EC.All the 377 cases were tested negative for HIV.Through data analysis,it showed that the mean age of EC patients was(52.79±12.777)years.The incidence rate of EC was showed significantly different in 5 age groups: 0.4% in group of younger than 20 years,0.2% in group of 20-40 years,0.3% in group of40-60 years,0.4% in group of 60-80 years,and 0.5% in group of elder than 80 years.In addition,the incidence rate of EC was also significantly different by gender: 0.4% in male group,while0.2% in female group.What's more,it showed the incidence rate of EC increasing in 5consecutive years from 2014 to 2018: 0.2% in 2014,0.2% in 2015,0.3% in 2016,0.3% in 2017,and 0.5% in 2018.Proton Pump Inhibitor was the most common risk factors of EC,accounting for 52%.it was followed by Antibiotics(28%),Corticosteroids(24%),while Surgical history(44%),drinking(8%),admission to ICU(20%),and Mechanical Ventilation(12%).Most of the 377 EC patients were asymptomatic,accounting for 53.44%,and the other46.56% had different gastrointestinal symptoms.The most common symptom was Epigastric Soreness(21.46%),followed by Acid Regurgitation(10.93%)and Dyspepsia(9.31%).The rest were typical manifestations of Esophageal Inflammation,such as Chest Discomfort,Dysphagia,and Odynophagia.Superficial gastritis was the most common coexisting EGD findings(47.75%).In addition,Reflux Esophagitis(23.08%),Chronic Erosive Gastritis(29.70%),Chronic Atrophy Gastritis(25.46%),Gastric Polyps(9.01%),Gastric Ulcer(6.1%),SMT(4.77%)and Duodenal Ulcer(3.18%)were also found to be common.Diabetes mellitus(17.39%)and malignant(13.04%)were the most common concomitant diseases,followed by Pulmonary disease(10.87%),Liver disease(6.52%),Cardiovascular disease(8.70%),Cerebrovascular disease(4.35%),and Rheumatoid Arthritis(4.35%).Conclusion In this study,we learned that the incidence rate of EC in EGD was 0.32%,the mean age of onset was(52.79±12.777)years old,and the elderly over 80 years old were susceptible groups.Male were more likely to suffer from EC than female.The incidence was increasing year by year in the past five years.Medical history,surgical history,admission to Intensive Care Unit,Mechanical Ventilation and drinking history are risk factors.In this study,it showed that Diabetes mellitus and Malignancy were the most common concomitant diseases.More than half had no gastrointestinal symptoms.Superficial Gastritis,Erosive Gastritis,Atrophic Gastritis or Reflux Esophagitis were often found in EC patients undergoing EGD.