칸디다 식도염에 대한 임상적 고찰 : 내시경 소견을 중심으로 A retrospective study, with emphasis on endoscopic findings = Esophagus, Stomach & Intestine;Candida Esophagitis

다국어 초록 (Multilingual Abstract)

Background/Airns: Generally, candida esophagitis has a low incidence of occurrence, but the prevalence of candida esophagitis was found to be higher in cases involving patients with impaired immunity due to an underlying disease and thereby using immunosupressive drugs. This study was designed to evaluate the relation of symptoms, endoscopic findings, and pathologic findings of each patient.
Methods: Between January 1993 and August 1996, 14,090 upper digestive tract endoscopies were done in Inha hospital. Among those patients, 20 cases of candida esophagitis (0.14%) were confirmed by an endoscopic biopsy. During these same endoscopic sessions, retrospectively reviews were conducted.
Results: Thirteen cases were male and seven cases were female with a range of 22∼79 years, and mean age of 47. The underlying disease was 12 cases of immunocompromise (chronic active hepatitis-3, diabetes mellitus-2, lymphoma-1, alcoholism-1, nephrotic syndrome-1, herpes zoster-1, ulceratve colitis-1, seborrheic dermatitis-1, cerebrovascular attack-1), 3 cases of esophageal organic disease (stricture-2, Barren esophagus-1), and five other cases. Nineteen patients had lower retrosternal pain, seven had dysphagia, and one had no symptoms. Regarding candida, six involved the whole esophagus, one on the upper one third, two on the mid portion, seven on the lower one third, and the remaining four were combined on the upper one third and mid portion, but two of the remaining four did not fully evaluate to the lower one third portion because of the esophageal stricture and submucosal tumor. Twelve patients were classified as having a di1-fuse scattering appearance, two as having a linear configuration, three as having a scattering of ring type lesions, and the remainder as having a conglomeration on the lower esophagus, diffuse scattering with ulcerations and conglomerations on the mid esophagus with diverticulum. By Baroukh, nine were classified as grade 1, nine as grade 2, and two as grade 3. Mucosal invasion of candida was seen nnicroscopically in ten of twenty patients. In the ten patients of candida invasion, seven of ten showed a diffuse scattering apperance. The sites of lesions with candida invasion were four on the whole esophagus, four on the lower third, and two combined on the lower third and mid portion. All five patients with prolonged steroid administration showed candida invasion microscapically, and four of them displayed a diffuse scattering apperance endoscopically. Fifteen patients were. treated with an antifungal agent and one patient was operated on for esophageal stricture. The remainders were not treated.
Conclusions: Candida esophgitis is more likely developed in immunocompromise patients with an underlying disease and prolonged steroid administration. All five patients with prolonged steroid administration showed candida invasion microscopically and four of them displayed a diffuse scattering apperance endoscopically. But in other cases, correlations between symptoms, endoscopic findings, and pathologic findings were not found. We need further prospective studies to clarify the correlations.