What is Esophageal Candidiasis: Symptoms, Causes, Treatment, Prognosis, Pathophysiology, Prevention

Candida albicans is an yeast which stays on the body and also on the skin. In case of a healthy individual when the immune system works normally, it acts as a normal flora of the mouth, throat, and the entire gastrointestinal tract. However, if there are some health problems or if a person has a compromised immune system, then the organism overgrows massively in the body causing pathogenesis. It leads to infections, which if not treated in time, can be fatal. Esophageal candidiasis is one such condition when there is yeast infection in the body due to this microorganism’s abnormal growth causing disturbance in the body.

During low immunity conditions, Candida albicans can overgrow to form candidiasis. The Candida albicans infection in the throat (esophagus) is called as Esophageal candidiasis. It is also called as Esophageal thrush or Oropharyngeal candidiasis. This infection is uncommon among healthy individuals. It is mainly observed in immune-compromised patients suffering from HIV-AIDS.

Esophageal candidiasis (oral thrush) shows the following symptoms:

• White patches or plaques on the throat and oral mucous membranes. They have cottage cheese like appearance.
• Redness in the affected areas
• Pain in the throat and mouth
• Pain and difficulty while swallowing
• Cracking at the corners of the mouth (angular cheilitis)
• Odynophagia
• Nausea and vomiting.

Overall there is an increase in the incidence of candidiasis. Esophageal candidiasis is the most common form of esophageal infection in AIDS patients and accounts for 50% of all esophageal infections. It occurs commonly in old age people and to the same extent in both genders.

Esophageal candidiasis can be painful. It spreads quickly throughout the body. When more body parts are affected, it is more severe. If left untreated then it can be life threatening. Prompt medication for esophageal candidiasis can reduce discomfort.

Esophageal candidiasis is caused due to the following factors:

• Age as a Risk Factor of Esophageal Candidiasis: It occurs more in elderly individuals and in babies less than 1 year of age.
• Esophageal Candidiasis Caused Due to Diabetes: Diabetes patients have excess of sugar in their blood, which is a good medium for the growth of Candida albicans. Hence, diabetic patients commonly suffer from these fungal infections.
• Weak Immune System: Patients with compromised immune system have a higher chance of having esophageal candidiasis. Patients who have a compromised immune system include:
  • HIV/AIDS, patients on broad spectrum antibiotics
  • Cancer patients
  • Organ transplantation
  • People using dentures.

The development of esophageal candidiasis is a two-step process in the case of immune-compromised patients. The first step involves colonization of the yeast to the esophagus. This is followed with a second step of invasion of the epithelial layer. Once colonization has been established, impaired cellular immunity, such as HIV infection, permits invasion of the epithelial layer.

The medication involving proton pump inhibitors, H1-receptor antagonists and prior vagotomy increase risk of esophageal candidiasis. At times, some antibiotics too predispose the individuals to risk of candidiasis. When not controlled the esophageal candidiasis leads to functional obstruction of esophagus with stasis and overgrowth of the yeast. However, the exact mechanisms of invasion are not been fully elucidated.

Candida albicans infection in the form of esophageal candidiasis is very common in the immune-compromised individuals. When not controlled or when yeast becomes resistant to the drugs then they lead to severe damage to the esophagus. They have a high potential of becoming systemic and causing a much more serious condition called as Candidemia (infection of Candida in the blood system).

The doctor will perform the physical examination by checking the oral cavity and record the medical history. Generally, esophageal candidiasis is diagnosed by using Endoscopy. Then the scrapping is obtained and grown under strict microbiological conditions. The colony characteristics indicate the presence of Candida albicans causing infection.

The goals of esophageal candidiasis treatment are to kill the yeast and prevent it from spreading. The type and duration of treatment to be given for esophageal candidiasis depends on factors such as age and immune status and on the severity of the infection.

• The anti-fungal medicine, Itraconazole is used for treatment in case of the immune-compromised patients. It is available in different forms as tablets, oral liquid, mouth wash and lozenges. It prevents spread of Candida and eliminates it from the body.
• In case of severe fungal infection, an anti-fungal medication called Fluconazole is given as intravenous fluids in hospitals.
• Patients, who are in late stage HIV, need to be given amphotericin-B medication.

One can prevent esophageal candidiasis by the following steps:

• To consume yoghurt when antibiotics are taken
• To treat vaginal yeast infections
• One should eat sugary foods within limits
• One should not eat too much of food that contains yeast
• If breast feeding mother is detected with candidiasis, then to apply antifungal cream to prevent the baby from getting infected.
• Practising good oral hygiene. Use chlorohexidine mouthwash to prevent oral candidiasis in people undergoing cancer treatment.
• A patient with regular use of inhaled corticosteroid may be able to avoid esophageal candidiasis by washing mouth and gargling with lukewarm water.
• HIV and AIDS patients are always at a greater risk of developing esophageal candidiasis. They should take prescribed antiretroviral therapy (ART).

Esophageal candidiasis is the most frequent yeast infection in immune-compromised host and leads to 20% of infections in the healthy individuals. Esophageal candidiasis needs to be diagnosed early so that they respond to the treatment. If not treated for a long time, they overgrow and cause extensive damage to the esophagus and eventually may infect the blood system too. Treatment is in the form of different types of anti-fungal agents which are administered depending on the age and severity of the disease. In case of the immune-compromised patients, the treatment regimens need to be altered to prevent drug resistant strains getting developed. Thus, if diagnosed properly and early, esophageal candidiasis can be controlled.