Candida esophagitis is an opportunistic infection occurring in oesophagus (food pipe), and is also known as monilial esophagitis / oesophageal thrush / oesophageal candidiasis. The candida species which cause this infection is naturally present in our mouth, gastrointestinal tract, vagina and as well as skin. Healthy individual are not affected by Candida esophagitis infections, and it occurs in people with compromised immunity due to various factors and underlying diseases. Sometimes it may occur in people with no risk factors and is generally asymptomatic in nature.
A person can suffer from Candida esophagitis infections after suffering from viral infections like HIV or AIDS, or undergoing treatment for cancer (chemotherapy), and patients who underwent an organ and bone marrow transplant. As during their illness they are on immunosuppressant medications. Individuals on kidney dialysis, or patients undergoing long term corticosteroid therapy and conditions like alcoholism, malnutrition, diabetes mellitus can lead to a compromised health status resulting in occurrence of Candida esophagitis as well. In few cases when babies are born vaginally may also develop this infection if the mother is suffering from vaginal yeast infection of Candida albicans.
Ulcers on the food pipe causing difficulty and pain while swallowing (eating and drinking).
Loss of appetite and weight loss.
Sensation of food sticking in neck and nausea.
Individual may experience burning chest pain.
In some cases a person may suffer from mild fever.
Oral candidiasis may also be present causing foul odor and bad taste in mouth.
The clinical signs of Candida esophagitis are odynophagia, concomitant thrush and weight loss.
Diagnosis of Candida esophagitis is initially made by a physical examination by a physician with detailed medical history. An EGD (Esophagogastroduodenoscopy) test is conducted in which the oesophageal tract is examined by endoscopy, and a tissue biopsy sample is collected during the procedure which is later examined by the pathologist to conclude and confirm the test results at microscopic level.
For treatment an antifungal is prescribed by the doctor to prevent the growth of the fungus and it is the first line of treatment. Depending upon the status and severity of the patient the treatment may vary. Sometimes painkillers are prescribed to ease the pain and discomfort experienced by the individual. The most commonly used drug is an antifungal called fluconazole, and other therapy drugs which can be used are nystatin, oral triazoles. Capsofungin and Amphotericin are used in systemic cases of the infection.
A study was published in June 2003 by the ‘Journal of International society for Disease’ of oesophagus in which patients were analyzed to determine the predisposing factors of Candida esophagitis. In brush cytology results fungus mycelia was found. During the study many predisposing risk factors like acid suppressive therapy, gastric surgery, mucosal barrier injury, steroid use, diabetes, antibiotic and rheumatologic disorders were determined. Candida esophagitis was less observed in associated malignancy. Most of the patients had more than one risk factor associated and 56% patients were treated with antifungal therapy.
Another study was conducted by “American Gastroenterological Association” in AIDS patients to demonstrate and analyze the pharmacological treatment of Candida esophagitis. In this study two antifungal drugs Fluconazole and Iitraconazole were used on two groups of HIV positive patients for a period of one year to establish the long term therapeutic efficacy of these drugs. At the end of follow up it was concluded that both drugs are efficient in treatment of the Candida esophagitis but fluconazole provided higher rate of cure as compared to Iitraconazole.
Above studies indicate that Candida esophagitis is an opportunistic fungal infection which is treatable and is linked to patients with compromised immunity and patients exposed to multiple predisposing risk factors. In both the studies patients were treated using antifungals. Even in AIDS patients fluconazole is effective and has lower failure rate in comparison to Iitraconazole thus proving fluconazole to be a better drug of choice in people suffering from it.
In order to prevent the reoccurrence or occurrence of the disease individual must maintain good oral hygiene, use mouth washes and rinse the mouth after sugary and starchy meals. Patient should take the prescribed medications timely. Prevention can be attained by treating the risk factors and chronic diseases resulting in Candida esophagitis.
The prognosis of Candida esophagitis is good and the treatment by fluconazole is highly effective in patients. Though prognosis may be less in immune-compromised individuals and individuals with complications like narrowing of oesophagus, perforation of oesophagus, spread of infection to other sites of body and side effects or allergic reaction from the antifungal medications used for the treatment.
Clinical findings for Candida esophagitis – Diseases of the Esophagus Journal – 2003 – By J. A. Underwood, J. W. Williams & R. F. Keate
Fluconazole versus itraconazole for Candida esophagitis – Gastroenterology Journal – 1996 – By Barbaro G, Barbarini G, Calderon W, Grisorio B, Alcini P & Di Lorenzo G