Prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate.
OBJECTIVE
Development of oropharyngeal candidiasis is a frequently reported adverse effect of inhaled corticosteroid use, but the prevalence of esophageal candidiasis is unknown. The aim of this study was to estimate the prevalence of esophageal candidiasis among patients treated with an inhaled corticosteroid, fluticasone propionate.


METHODS
Upper GI endoscopy was performed on 49 patients treated with inhaled fluticasone propionate to examine the prevalence of esophageal candidiasis. Of the patients, 36 had bronchial asthma and 13 had chronic obstructive pulmonary disease. To compare the prevalence with control patients, upper GI endoscopy was performed on 700 consecutive patients without malignancy or immunosuppression.


RESULTS
The prevalence of esophageal candidiasis was 37% among patients treated with inhaled fluticasone propionate, whereas only 0.3% of the control patients had the infection. The prevalence was especially high among patients with diabetes mellitus or those who were treated with a high dose of inhaled fluticasone propionate. Moreover, a reduction in the daily dose of inhaled fluticasone propionate eliminated the infection in four of five patients.


CONCLUSIONS
Esophageal candidiasis is a common complication of inhaled corticosteroid use.
Kanda
Naoki
N
Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Yasuba
Hirotaka
H
Takahashi
Teruko
T
Mizuhara
Yuka
Y
Yamazaki
Syuji
S
Imada
Yuko
Y
Izumi
Yoshio
Y
Kobayashi
Yoshiki
Y
Yamashita
Kenzo
K
Kita
Hideo
H
Tamada
Takashi
T
Chiba
Tsutomu
T
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy; D002177:Candidiasis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004945:Esophagoscopy; D004947:Esophagus / Q000187:drug effects*; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D018570:Risk Assessment; D017678:Sex Distribution
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D000068298:Fluticasone