PATIENTS with achalasia who develop oesophageal Candida infections may be at significantly higher risk of oesophageal cancer, according to a large retrospective cohort study.
Researchers at Erasmus University Medical Center in the Netherlands followed 234 patients with achalasia for a median of 13 years. Oesophageal Candida infection was found in 12% of the cohort, while 10% of patients went on to develop oesophageal cancer over time. After adjusting for age and sex, the presence of Candida infection was associated with an 8.2-fold increased risk of oesophageal cancer.
The link was particularly strong for oesophageal squamous cell carcinoma, where the adjusted hazard ratio rose to 13.6. Older age at diagnosis and male sex also independently increased cancer risk.
“Candida is often considered a secondary infection due to food stasis in achalasia,” the authors wrote, “but our findings suggest it may play a more active role in malignant transformation.”
Currently, there is no universal guideline for cancer surveillance in achalasia, partly due to the lack of robust risk stratifiers. These new findings could help fill that gap. The authors recommend clinicians document any Candida infection observed during endoscopic evaluation and consider more regular surveillance for those affected.
With a median disease duration of over 16 years in this study, the results underscore the importance of long-term monitoring, and the potential consequences of overlooking seemingly benign infections.
Reference
Guo X et al. Esophageal Candida Infection and Esophageal Cancer Risk in Patients With Achalasia. JAMA Netw Open. 2025;8(1):e2454685.
