Treatment, aetiology and HIV testing in patients diagnosed with oesophageal candidiasis

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Introduction

Although oesophageal candidiasis can develop in healthy people, it is much more likely in those who are immunocompromised. Upon diagnosis it is recommended that risk factors should be sought and eliminated.(1) It is unclear how many patients diagnosed with it get appropriate treatment, have potential aetiology considered or get tested for HIV.

Methods

Data were gathered using NI-ECR and OGD reports for all Belfast Trust patients histologically diagnosed with oesophageal candidiasis in the period of June 2012 – September 2013. They were assessed for; i) whether they were treated, ii) potential aetiology (concurrent antibiotics, inhaled steroids, immunosuppressants, malignancy, diabetes, achalasia, oesophageal stricturing) and iii) whether they were tested for HIV. “Treated” includes treatment recommended to GPs via letter or OGD report, or evidence of anti-fungal prescription on NI-ECR. “Tested for HIV” includes HIV blood test within 6 months after diagnosis or referral to GUM clinic.

Results

45 cases were included. Of these 33 (73%) were treated, 12 (27%) were not. 18 (40%) had no potential aetiology identified. The most common aetiologies were inhaled steroids (12 cases), immunosuppressants (8 cases), diabetes (5 cases) and oesophageal stricturing (5 cases). 7 patients (16%) were tested for HIV, 38 (84%) were not tested. Of the 7 tested, 1 patient was found positive.

Conclusion

1) Although most patients were treated for candida, this number could be improved. 2) Only a small percentage of patients were tested for HIV. 3) We are not good at checking for causative aetiology, including HIV, when oesophageal candidiasis is present.

References

1. Feldman M SM, Scharschmidt BF et al. Sleisenger and Fortran’s Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: WB Saunders Co, 1998; p522.