ArticleJAMA network open2025
Esophageal Candida Infection and Esophageal Cancer Risk in Patients With Achalasia.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Modern treatment for achalasia: endoscopic and surgical therapies.The British journal of surgery · 2026Review
- Beyond Mechanical Failure: Esophagitis Causing Post Myotomy Obstruction in Congenital Achalasia.Oman medical journal · 2026Article
- Early esophageal squamous neoplasia and the microbiome: evidence, mechanisms, and early-detection potential.Frontiers in microbiology · 2026Review
- The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2026Article
- Atypical presentation of esophageal Dieulafoy: diagnostic and therapeutic challenges in end stage achalasia.Journal of surgical case reports · 2025Article
- The trio of Candida albicans, immune cells, and cancer progression: a complex interplay driving tumorigenesis.Medical oncology (Northwood, London, England) · 2025Review
- A landscape review with novel criteria to evaluate microbial drivers for cancer: priorities for innovative research targeting excessive cancer mortality in sub-Saharan Africa.Frontiers in cellular and infection microbiology · 2025Review
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Authors and funding
9 authors.
Funding
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Abstract
Importance: Patients with achalasia face a higher risk of developing esophageal cancer (EC), but the surveillance strategies for these patients remain controversial due to the long disease duration and the lack of identified risk factors. Objective: To investigate the prevalence of esophageal Candida infection among patients with achalasia and to assess the association of Candida infection with EC risk within this population. Design, Setting, and Participants: This retrospective cohort study included patients with achalasia diagnosed at or referred for treatment and monitoring to the Erasmus University Medical Center in Rotterdam, the Netherlands, between January 1, 1980, and May 31, 2024. Data analysis was conducted from August 1 to October 31, 2024. Exposure: Esophageal Candida infection. Main Outcomes and Measures: The primary outcomes were the prevalence of esophageal Candida infection and its association with EC development among patients with achalasia. Associations were estimated using time-dependent Cox proportional hazards regression models with esophageal Candida infection as a time-varying covariate, adjusting for age at diagnosis and sex. Results: This study included 234 patients with achalasia (median [IQR] age at diagnosis, 45 [32-63] years; 117 [50%] male), with a median follow-up time of 13 (4-22) years. Esophageal Candida infection was identified in 29 patients (12%), while EC was observed in 24 patients (10%). Esophageal cancer risk analysis was performed for 207 patients with 2 or more consecutive endoscopy follow-up visits (median [IQR] age at diagnosis, 43 [32-60] years; 104 [50%] male). The median (IQR) follow-up time for this subgroup was 16 (9-26) years. Among these patients, esophageal Candida infection was independently associated with an increased risk of EC (adjusted hazard ratio [AHR], 8.24 [95% CI, 2.97-22.89]). Additionally, age at diagnosis (AHR, 1.06 [95% CI, 1.03-1.10]) and male sex (AHR, 3.34 [95% CI, 1.08-10.36]) were independently associated with EC risk. Conclusions and Relevance: This retrospective cohort study found that prior esophageal Candida infection, older age at diagnosis, and male sex were associated with increased risk of EC among patients with achalasia. These findings provide an important rationale for optimizing the monitoring of patients with achalasia.
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