Acid suppressing therapy as a risk factor for Candida esophagitis

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pharmacology

Background:

• Acid-suppressing therapies, particularly proton pump inhibitors (PPIs), are widely used.
• These therapies can significantly increase Candida populations in the upper gastrointestinal tract.
• The impact of PPIs on Candida esophagitis development and recurrence is a growing concern.

Purpose of the Study:

• To review risk factors for Candida esophagitis, including those influenced by acid-suppressing therapy.
• To investigate the mechanisms by which acid-suppressing therapy affects Candida colonization and infection.
• To evaluate the potential benefits of limiting PPI use in patients with or at risk for Candida infections.

Main Methods:

• Systematic review of studies from PubMed.
• Analysis of risk factors for Candida esophagitis development, recurrence, prevention, and therapy.
• Examination of mechanisms induced by acid-suppressing therapy, including PPIs and H2-blockers.

Main Results:

• Acid-suppressing therapy greatly increases Candida populations in the mouth, esophagus, stomach, and small intestine.
• PPI consumers, especially those without HIV, had higher rates of Candida esophagitis and recurrence than non-consumers.
• PPIs impair the absorption of oral antifungal agents, potentially limiting treatment efficacy.

Conclusions:

• PPI use is associated with increased risk and recurrence of Candida esophagitis.
• Limiting PPI use in susceptible patients may be beneficial for managing Candida infections.
• Further research on PPI risk-benefit ratios in these populations, including those with HIV, is warranted.