Candida Esophagitis

Candida Esophagitis

What is Candida Esophagitis?

Esophagitis happens to be a state of inflammation or irritation of the esophagus, which is the tube that carries food from the throat to the stomach. These irritations and inflammations can be quite painful and it makes almost impossible to swallow.

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.

 

Who Can Suffer from Candida Esophagitis?


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.

 
 

What are the Symptoms of Candida Esophagitis?

  • 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.

 
 

What is the Diagnosis and Treatment for Candida Esophagitis?

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.

 

Candida Esophagitis Examination

Candida Esophagitis Examination

 

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.
 


 

 

Eosinophilic Esophagitis

Alternatively known as allergic esophagitis, happens to be an allergist, and inflammation of the esophagus and it involves Eosinophils, which are specific type of white blood cells. The typical symptom of Eosinophilic Esophagitis involves difficulties in swallowing, vomiting tendencies, heartburn, as well as food impact.

Though the trouble of Eosinophilic Esophagitis is primarily related to infants, it has however got every potential to attack adults as well. Even if the condition is not fully known, still it has been found that food allergies play a major role in triggering these issues. Usually, the treatment involves the process of the elimination of the identified or the suspected factors and the application of suitable medication for suppressing the response of the immune system. In instances of severity, it might require the care provider to enlarge the esophagus, by the application of the endoscopy procedure.

The signs and symptoms of this form of Esophagitis vary in adults and infants. In adults, the usually observed issues are difficulties in swallowing, or instances of food getting stuck in the esophagus, after swallowing, and the feeling of intense chest pain that never ever gets eliminated, even after taking antacids. In addition, adults are likely to experience persistent heartburns and catching pain in the upper parts of the abdomen. Undigested foods back flowing is also observed in these victims.

 

Following are the most commonly observed symptoms in infants:

  • Difficulties in feeding and eating

  • Persistent vomiting tendencies

  • Severe pains in the abdomen

  • Troubles in swallowing or foods getting stuck in the esophagus

  • Abrupt weight loss, malnutrition and inadequate growth

As the signs and symptoms of these ailments significantly vary in adults and infants, it is needless to say that different type of approaches is required to treat the troubles in these cases. One point will be highly relevant to state that these symptoms resemble the outbursts of various other ailments, and hence you should not approach own medication based on these signs. By taking the correct suitable medical care in a timely manner, you can certainly win over these challenges and restore back happiness in your life. Thus, the moment you see these troubles, you should rush to the doctors at its earliest.

Discussing about this type of Esophagitis, it will be relevant to refer to the observations made by the team headed by Chris A. Liacouras. The team conducted a research that involved around 400 respondents and spanning for a decade between 1994 and 2004. As per their observations, the troubles sometimes come, in a state when no major abnormalities are visible in the Esophagus. However, in some cases, major changes in the structure and shape of the esophagus were also observed. Thus, it will be right to say that the signs and symptoms of this ailment is likely to vary on a case to case basis.

 

Esophageal Varices


Alternatively known as Oesophageal Varices, Esophageal Varices are the sub-mucosal veins that are highly supple and lay in the lower 3rd region of the esophagus. In the majority of the instances, this condition is the outcome portal hypertension that happens mainly due to Cirrhosis. Patients, suffering from this ailment have strong tendencies towards bleeding. Typically, the detection of this ailment involves using the Esophagogastroduodenoscopy.
The draining of the upper 2/3rd of the esophagus involves the esophageal veins that carry the de-oxygenated blood to the azygos from the esophagus. In turn, it drains into the vena cava, directly. These veins play no part in triggering Esophageal Varices. The lower 1/3rd part of the esophagus gets drained into the lining of the superficial veins of the Esophageal Mucosa, draining into the coronary vein. The diameter of the superficial veins gets distended to the extent of 1 to 2 cm, happening in association with the portal hypertension.
The normal range of the Portal pressure usually stays around 9 mmHg, in contrary to the pressure of the inferior Vena Cava that varies in the range between 2 and 6 mHg. In instances, the portal pressure crosses the extent of 12 mmHg, the gradient range of the pressure goes to the extent of 7 to 10 HMG, compared to its normal standing in the range between 3 to 7 mmHg. When the gradient pressure exceeds the extent of 5 mmHG, Portal Hypertension takes place.
If the gradient pressure exceeds the extent of 10 mmHg, blood flows takes the path through the system of hepatic portal and gets redirected from the hepatic region to the areas having lower venous pressure. It implies a development of collateral circulation along the lower part of the esophagus, walls of the abdomen, stomach, as well as the rectum. The tiny blood vessels in this region get distended, taking a more thin-walled appearance, appearing as Varicosities.
If the Portal pressure enhances, there appears dilation of the anastomosis veins and it paves the way for esophageal varices. One of the rare conditions is that of Splenic Vein Thrombosis that triggers the emergence of this form of Esophagitis, appearing even without the enhanced portal pressure. It is likely that these troubles can appear in other parts of the body, with the stomach, duodenum and the rectum being the most vulnerable areas to get affected by Esophageal Varices.

 

Esophageal Spasm

A condition of painful contractions of the muscular tube that connects the mouth to the stomach, Esophageal Spasm can produce a feeling like severe and sudden chest pain and usually persist for a few minutes to hours. These troubles will only appear occasionally and it never ever needs any treatment. However, in some instances, Esophageal spasms can appear more frequently and block the path for foods and liquid to move through the esophagus. In such instances, the conditions are interfering with the inherent abilities, the troubles can be easily overcome with simple treatments.
Following are the most common symptoms of this type of Esophagitis:

  • Feeling of a squeezing pain in the chest that often intensifies and gives a common misunderstanding for heart pain.

  • You are likely to experience troubles in swallowing specific items like extremely hot or cold foods and liquids.

  • A feeling that something has got stuck in the throat.

  • Backflow of the foods and liquids through the esophagus.

Speaking of the probable causes that trigger these ailments, though not much information have been explored till date, however, in the majority of the instances, this condition happens due to the malfunctioning of the nerves, monitoring the muscles involved in swallowing.
Individuals, having the habit of eating or drinking excessively hot or cold foods and liquids, or consuming red wine in excessive extent as well as those individuals, suffering from excessively high blood pressure, anxiety and depression, are more vulnerable to catch this ailment. Hence, these individuals need to stay more careful than their counterparts, not having the history of these instances.

If adequate medical care is approached in a timely manner, the troubles with Esophagitis will hardly ever turn crucial, and you can expect to get complete freedom to these problems within the shortest time span.

 

Study Evidence on Risk Factors of Candida Esophagitis in Outpatients and its Effective Treatment in Aids Patients

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.

 
 

Prevention and Prognosis of Candida Esophagitis


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.

 

References:
Clinical findings for Candida esophagitis – Diseases of the Esophagus Journal – 2003 – By J. A. Underwood, J. W. Williams & R. F. Keate
http://onlinelibrary.wiley.com/doi/10.1046/j.1442-2050.2003.00305.x/full

 

Fluconazole versus itraconazole for Candida esophagitis – Gastroenterology Journal – 1996 – By Barbaro G, Barbarini G, Calderon W, Grisorio B, Alcini P & Di Lorenzo G
https://www.ncbi.nlm.nih.gov/pubmed/8898629

 
Eosinophilic Esophagitis (10-Year Experience in Children) – Clinical gastroenterology and hepatology Journal – 2005 – By Chris A.Liacouras, Jonathan M.Spergel, Eduardo Ruchelli..
http://www.cghjournal.org/article/S1542-3565(05)00885-2/abstract

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