Journal Article

OC82 Candida esophagitis in paediatric patients with eosinophilic oesophagitis: a monocentric case – control study

Pellegrino, Francesco, Palm, Liina, Gaynor, Edward

2024

Overview

Eosinophilic oesophagitis (EoE) is a chronic inflammatory condition of the oesophagus, which presents in children and adults with swallowing difficulties, abdominal and chest pain, vomiting, nausea and/or with symptoms affecting eating and appetite.1 EoE can present a white exudate or plaques in the oesophagus - a finding not dissimilar to those with oesophageal candidiasis (OC). To exclude OC, Periodic acid-Schiff (PAS) staining is recommended.2 The aim of the study is to report the incidence of positive PAS staining in patients with EoE and idenitify possible risk factors for OC.A single-center retrospective case-control study was conducted. We reviewed all patients with a diagnosis of EoE (n = 111). We excluded those which had other possible risk factors for OC, as oesophageal atresia (n= 20) and severe immunodeficiency (n=1) and we selected only patients for which we required at least one time PAS staining for suspected OC (n=36, 40%) either at the time of endoscopy or due to associated features on oesophageal histology such as infiltration of the surface with mononuclear cells.We enrolled a total of 26 patients, 3 with positive PAS staining and 23 with negative PAS staining. The prevalence of OC in patients with EoE, without known risk factors is 3.3%, greater than in non-immunosuppressed population as reported in the literature (0.32–0.4%).3 4 Those children who underwent PAS-staining due to suspected of OC was principally due to the presence of white exudate or plaques in the oesophagus at the oesophagogastroduodenoscopy (n= 22 patients, 85%), isolated or with other oesophageal macroscopic changes.In order to find possible risks factors for OC in patients with EoE, we compared patients with confirmed OC with those with suspected OC but not confirmed with PAS-staining.We identified those with known IgA deficiency and on recent antibiotics therapy and H. pylori infection. We also assessed length of therapies with proton pump inhibitors (PPI) and topical steroids (inhaled or swallowed) for EoE; significant statistical correlation was not found with any of these factors.Our study suggests that OC prevalence in EoE is increased compared to reported prevalence of OC in non-immunosuppressed population, but no clear risk factors were detected. Due to the small number of cases observed, further studies on larger populations are needed to assess the indications for PAS staining in EoE patients and real risk of OC in this population.PAS staing is recommended to aid diagnosis of OC with children with known EOE.ReferencesDhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459–1487.O’Donnell JEM, Krishnan U. Infectious Esophagitis in Children. J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):556–563. doi: 10.1097/MPG.0000000000003523. Epub 2022 Jun 10. PMID: 35687591.Choi JH, Lee CG, Lim YJ. Prevalence and risk factors of esophageal candidiasis in healthy individuals: a single center experience in Korea. Yonsei Med J. 2013 Jan 1;54(1):160–5.Chen YH, Jao TM, Shiue YL. Prevalence and risk factors for Candida esophagitis among human immunodeficiency virus-negative individuals. World J Clin Cases 2022;10(30):10896–10905.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Abstracts / Antibiotics / Gastroenterology / Immune system / Pediatrics / Risk factors