Alternate Names: Candida infection - esophagus; Yeast infection - esophagus

Causes and Risks: Oral candida or thrush is an unusual finding in the young adult (it is somewhat more common in the elderly). It often heralds a decrease in the ability of the immune system to fight off an organism that normally does not cause severe disease. People with AIDS or others with damaged immune systems (organ transplant recipients, diabetics, those undergoing chemotherapy, and children with advanced leukemia or lymphoma) are at risk for candidal infections.

Candidal esophagitis occurs when the organism spreads from the mouth down the esophagus. Swallowing becomes difficult and painful. Fever may occur if there is further dissemination (spreads) of the fungus.

Oral thrush or yeast infection predisposes an immunocompromised person to esophagitis. The incidence is 1 in 10,000 persons.

Prevention: Prevention of AIDS prevents opportunistic infections such as candida. (Opportunistic infections are infections by organisms that are not normally disease producing but take advantage of a situation such as a damaged immune system.) Good oral hygiene may reduce the risk of infection.

Symptoms:

• difficulty swallowing
• painful swallowing
• may have Candida in the mouth (oral thrush, with white mouth sores)

Signs and Tests: Tests that show Candida include:

• an EGD (esophagogastroduodenoscopy) with or without biopsy
• a culture of esophageal brushing
• a throat swab culture
• an upper GI and small bowel series (gastrointestinal X-rays)

Treatment: The objective of treatment is to eliminate the infection with antifungal medications such as ketoconazole and fluconazole. Amphotericin B may be used if other treatment fails.

Prognosis: Esophagitis can usually be treated effectively; the outcome depends upon the underlying immunodeficiency that makes the person more susceptible to the infection.

Complications:

• recurrent infection
• spread of Candida to other sites

Call for an appointment with your health care provider if symptoms of esophagitis develop, particularly if you are known to be immunosuppressed.