Risk factors for oral and esophageal candidiasis during budesonide treatment in eosinophilic esophagitis patients

Eosinophilic esophagitis (EoE) first-line therapy is represented by budesonide orodispersible tablets (BOT), but a very low number of patients develop oral and esophageal candidiasis. The aim of the study is to evaluate risk factors for the development of oral and esophageal candidiasis during budesonide therapy in EoE patients. A retrospective study was conducted to include all EoE patients in BOT therapy referred to our center. Prevalence, localization, and time of presentation of candidiasis, eosinophilic count in gastroscopy before BOT therapy, and concomitant treatment with proton pump inhibitors (PPI) and its dosage were reviewed. A total of 46 EoE patients in BOT therapy were included in the study. 7 patients (15%) developed oral and/or esophageal candidiasis. 4 patients (57%) of this group were in concomitant PPI therapy, all at 40 mg per day or more dosage, whereas 38% of patients without mycosis were taking this medication (41% at 40 mg per day or more). The mean eosinophil count before treatment was 45/HPF in patients with candidiasis infection and 33/HPF for the others without. Concomitant PPI therapy and high eosinophilic count may represent risk factors in developing mycosis in EoE patients.