Patients with achalasia and prior esophageal Candida infection face an over eightfold increased risk of developing esophageal cancer, according to a recent study.
Researchers investigated the association between esophageal Candida infection and esophageal cancer (EC) risk in patients with achalasia. This retrospective cohort study, published in JAMA Network Open, included 234 patients diagnosed with achalasia between 1980 and 2024 at Erasmus University Medical Center, Rotterdam, Netherlands. The study aimed to determine the prevalence of esophageal Candida infection and its role in EC development within this population, given the established but poorly understood increased cancer risk in achalasia.
Patients with insufficient diagnostic data or inadequate follow-up were excluded, leaving 207 patients for risk analysis. The cohort had a median age of 45 years at diagnosis, with 50% male patients. The median follow-up duration was 13 years. During follow-up, 12% (n = 29) of patients experienced esophageal Candida infection, and 10% (n = 24) developed EC, predominantly esophageal squamous cell carcinoma (ESCC; 79%).
Using time-dependent Cox proportional hazards regression models, the researchers identified esophageal Candida infection as a significant risk factor for EC. Male sex and older age at diagnosis were also independently associated with increased EC risk. Among patients with ESCC, the association was even stronger, with Candida infection conferring a 13.6-fold increased risk.
The Kaplan-Meier analysis demonstrated a gradual increase in EC risk approximately 10 to 20 years post-achalasia diagnosis, with Candida infection primarily occurring within the first 2 decades. Despite common interventions such as pneumatic dilation (received by 97% of patients), esophageal Candida infection persisted, highlighting the ongoing susceptibility associated with prolonged food retention and esophageal conditions.
The findings support increased surveillance for esophageal Candida infection in patients with achalasia. The researchers recommend regular endoscopic monitoring for early detection of EC, particularly in those with documented Candida infections, to improve outcomes and guide future preventative strategies.
Full disclosures can be found in the published study.
