Esophageal Candidiasis

Overview

Esophageal candidiasis is an infection of the esophagus, the muscular tube that carries food from the throat to the stomach, caused by an overgrowth of Candida, a type of yeast. Small amounts of Candida normally live in the mouth and digestive tract without causing harm. When the immune system is weakened or the normal balance of microbes is disturbed, the yeast can multiply and infect the lining of the esophagus.

This infection most often affects people whose immune defenses are lowered, such as those with HIV, those receiving chemotherapy, or people taking certain medications. It causes painful, difficult swallowing and usually responds well to antifungal treatment. In someone with a weakened immune system, esophageal candidiasis is sometimes one of the first signs that immunity is low, so finding it can prompt a search for an underlying cause. In otherwise healthy people, the infection is uncommon, and its appearance usually points to a contributing factor such as inhaled steroids or poorly controlled diabetes.

Symptoms

The main symptoms involve swallowing and discomfort behind the breastbone:

• Pain when swallowing (odynophagia)
• Difficulty swallowing, or a feeling that food is stuck (dysphagia)
• Pain or discomfort behind the breastbone
• Nausea
• Loss of appetite and, sometimes, weight loss

Many people also have visible white patches in the mouth and throat (oral thrush), although esophageal infection can occur without them. Severe pain that prevents eating or drinking, leading to dehydration, needs prompt medical attention.

Causes

The infection develops when Candida yeast, normally kept in check by the immune system and other microbes, overgrows in the esophagus. This is most likely when the body's defenses are reduced or the normal balance is disrupted.

• Weakened immunity: HIV/AIDS, cancer treatment, organ transplant medications, or steroid use.
• Inhaled or swallowed corticosteroids, such as asthma inhalers used without rinsing the mouth.
• Antibiotics, which can upset the normal balance of microbes.
• Diabetes, especially when blood sugar is poorly controlled.
• Conditions that slow the esophagus, allowing yeast to linger.

Risk Factors

• HIV/AIDS or other causes of a weakened immune system
• Cancer and chemotherapy
• Long-term corticosteroid use, including inhalers
• Recent or frequent antibiotic use
• Diabetes, particularly when poorly controlled
• Older age and dentures

Diagnosis

Doctors often suspect esophageal candidiasis in a person with painful swallowing and risk factors, especially if oral thrush is present. To confirm it, they may use:

• Upper endoscopy: A thin camera passed through the mouth to view the esophagus, which typically shows white plaques on the lining.
• Biopsy or brushing: A small sample taken during endoscopy to confirm Candida and rule out other causes.
• Trial of treatment: In some cases, antifungal medication is started based on the symptoms and improvement supports the diagnosis.

Because painful swallowing can have other causes, including viral infections, testing helps confirm the diagnosis when the picture is unclear.

Treatment

Esophageal candidiasis is treated with antifungal medication, usually given by mouth.

• Oral antifungals: Fluconazole is the standard treatment for most people, taken for one to a few weeks.
• Alternative antifungals: Used if the infection does not respond or if the person cannot take fluconazole.
• Intravenous antifungals: For severe infections or when swallowing pills is not possible.
• Treating the underlying cause: Improving immune function, controlling diabetes, or adjusting medications helps prevent the infection from returning.

Most people improve within a few days of starting treatment. Recurrent infections may prompt a search for an underlying immune problem.

Prevention

• Rinse your mouth and spit after using a steroid inhaler
• Keep diabetes well controlled
• Use antibiotics only when needed
• Manage HIV and other immune conditions as advised by your doctor
• Practice good oral hygiene and treat oral thrush promptly

When to See a Doctor

See a doctor if you have pain or difficulty swallowing that lasts more than a day or two, especially if you have a weakened immune system or white patches in your mouth. Seek prompt care if you:

• Cannot swallow enough to stay hydrated
• Have severe chest pain when swallowing
• Are losing weight because eating hurts
• Have a fever along with swallowing pain

Related Topics

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention (CDC). Candida infections of the mouth, throat, and esophagus.
2. MedlinePlus, U.S. National Library of Medicine. Esophagitis.
3. National Institute of Allergy and Infectious Diseases (NIAID). Fungal diseases.
4. Mayo Clinic. Oral thrush — Symptoms and causes.