Negative Association between the Occurrence of Esophageal Candidiasis and Reflux Esophagitis

Objective Reflux esophagitis (RE) is caused by gastroesophageal acid reflux, whereas the heterotopic gastric mucosa (HGM) of the cervical esophagus often shows acid secretion. This study investigated whether an intra-esophageal acidic condition in patients with RE or HGM prevents the occurrence of esophageal candidiasis. Materials We enrolled 5,221 adults (males/females: 3,260/1,961, mean age 54.8±9.8 years) who underwent an esophagogastroduodenoscopy (EGD) examination as part of a medical checkup. The presence of esophageal candidiasis, RE, and/or HGM in the cervical esophagus was endoscopically determined, and the risk factors for esophageal candidiasis were investigated. Results The EGD findings revealed esophageal candidiasis, RE, and HGM of the cervical esophagus in 176 (3.4%), 1,119 (21.4%), and 367 (7.0%) patients, respectively. A multiple logistic regression analysis showed that an older age, habitual alcohol consumption, and comorbidities (poorly controlled diabetes mellitus, bronchial asthma with steroid therapy, autoimmune disease with immunosuppressive treatment, and/or malignant disease with chemotherapy) were significant risk factors, whereas RE was negatively correlated with esophageal candidiasis. HGM of the cervical esophagus was not significantly related to its occurrence. Conclusion Esophageal candidiasis was found in 3.4% of the subjects who underwent EGD for a medical checkup. RE was negatively correlated with esophageal candidiasis, whereas HGM of the cervical esophagus did not show such an association.