Prevalance of esophageal candidiasis in patients treated with ınhaled and short course systemic steroids

Abstract

Objective: We aimed to investigate the frequency of esophageal candidiasis by performing upper gastrointestinal system (GIS) endoscopy in patients with asthma and chronic obstructive pulmonary disease (COPD) who were already using inhaled steroids and hospitalized for acute attack and initiated systemic steroids. Methods: Ten patients with COPD and 11 patients with asthma, hospitalized for acute attack, were accepted to the study (steroid group). These patients were using inhaled steroids for at least one year. They were initiated daily 40 mg methyl-prednisolone for acute attack in the hospital. Systemic steroid treatment was ceased at the 7-10th day when the patients were clinically stable. Upper GIS endoscopy was performed. Biopsy was obtained to confirm candidiasis when white plate was seen. Five hundred and fifty five consecutive patients who admitted to gastroenterology polyclinic with upper GIS complaints and do not have malignancy or immunosupression were accepted to the study as a control group. Results: Frequency of esophageal candidiasis was 42.9% in the steroid group and 0.2% in the control group. Conclusion: Frequency of esophageal candidiasis has been increased in patients using inhaled steroids for a long time. Addition of short course systemic steroids further increases this frequency.

Amaç: İnhale steroid kullanmakta olan ve akut atak nedeniyle hastaneye yatırılarak sistemik steroid baş- lanan astım ve kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda üst gastrointestinal sistem (GİS) endoskopisi ile özefagial kandidiyazis sıklığını araştırmayı amaç- ladık. Yöntem: Akut atak nedeniyle hastaneye yatırılmış olan 10 KOAH hastası ve 11 astım hastası çalışmaya alındı (steroid grubu). Bu hastalar en az 1 yıldır inhale steroid kullanmakta idiler. Bu hastalara akut atak tedavisi için günlük 40 mg metil-prednizolon başlandı. Tedavinin 7-10. gününde hastalar stabil hale gelince sistemik steroid kesildi ve üst GİS endoskopisi yapıldı. Beyaz plak görülen hastalardan biyopsi alındı. Gastroenteroloji polikliniğine üst GİS semptomlarıyla başvuran ve malignitesi ya da immünsüpresyonu olmayan grubu olarak çalışmaya alındı. Bulgular: Özefagial kandidiyazis sıklığı steroid grubunda %42.9 ve kontrol grubunda %0.2 olarak bulundu. Sonuç: Uzun süredir inhale steroid kullanan hastalarda özefagial kandidiyazis sıklığı artmaktadır. Bu tedaviye sistemik steroidlerin kısa süreli eklenmesi bu sıklığı artırmaktadır.