Esophageal Thrush (Candida Esophagitis)

What Is Esophageal Thrush?

Esophageal thrush is a yeast infection of the throat. The condition is also known as oral candidiasis or oropharyngeal candidiasis.

Fungi in the family Candida cause esophageal thrush. There are about 20 species of Candida that can cause the condition, but it’s usually caused by Candida albicans.

How Does Esophageal Thrush Develop?

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Traces of the fungus Candida are normally present on the surface of your skin and within your body. Normally, your immune system can regulate these good and bad bacteria and microbes in your body. Sometimes, though, a shift in the balance between the Candida and your healthy bacteria can cause the yeast to overgrow and develop into an infection.

Who Is at Risk?

Risk Factors

If you’re healthy, it’s unlikely you will develop this condition. People with compromised immune systems, such as those with HIV, AIDS, or cancer, and older adults are at a higher risk. According to the Centers for Disease Control and Prevention (CDC), 20 percent of all cancer patients develop the condition.

People with diabetes are also at an increased risk of developing esophageal thrush, especially if their sugar levels are not well controlled. If you have diabetes, there’s often too much sugar present in your saliva. The sugar allows the yeast to thrive.

Babies who are born vaginally can develop oral or esophageal thrush if their mothers had a yeast infection during delivery. Infants can also develop thrush from breast-feeding if their mother’s nipples are infected.

There are other risk factors that make someone more likely to develop this condition. You’re more at risk if you:

  • smoke
  • wear dentures or partials
  • take certain medications, such as antibiotics
  • have a dry mouth
  • eat lots of sugary foods
  • have a chronic disease

Identifying the Symptoms of Esophageal Thrush

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The symptoms of esophageal thrush include:

  • white lesions on the lining of your throat (esophageal lining), which may look like cottage cheese and may bleed if they’re scraped
  • pain in your throat and mouth
  • dry mouth
  • pain when swallowing
  • difficulty swallowing
  • nausea
  • vomiting
  • weight loss
  • chest pain

It’s also possible for esophageal thrush to spread to the inside of your mouth and become oral thrush. The symptoms of oral thrush include:

  • creamy white patches on the inside of the cheeks
  • white lesions on the roof of your mouth, tonsils, and gums
  • cracking in the corner of your mouth

Breast-feeding moms can experience Candida infection of the nipples, which they can pass on to their babies. The symptoms include:

  • especially red, sensitive, cracking, or itchy nipples
  • stabbing pains felt deep within the breast
  • significant pain when nursing or pain between nursing sessions

If you experience these conditions, you should watch your baby for signs of infection. While babies can’t say if they’re feeling bad, they may become more fussy and irritable. They can also have the distinctive white lesions associated with thrush.

Esophageal Thrush: Testing and Diagnosis

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If your doctor suspects you might have esophageal thrush, they will either perform a throat culture or do an endoscopic exam.

Throat Culture

A throat culture will check for the presence of bacteria and fungus in your esophagus. During the exam, a cotton swab will be used to swipe your throat. The liquid picked up on the swab is then dabbed into a petri dish, or onto a slide, for viewing.

Since Candida normally live in your mouth flora, seeing the fungus on a culture may not be enough to indicate esophageal thrush. Your doctor may need to do an endoscopic exam to confirm the diagnosis.

Endoscopic Exam

During this exam, your doctor looks down your throat using an endoscope. This is a small, flexible tube with a tiny camera and a light at the end. This tube can also be lowered into your stomach or intestines to check the extent of the infection.

Treating Esophageal Thrush

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The goals of treating esophageal thrush are to kill the fungus and prevent it from spreading.

Healthy Adults

If you have esophageal thrush but you’re otherwise healthy, your doctor may recommend that you eat yogurt or take acidophilus to treat the infection. These treatments don’t kill fungus, but they can restore the natural balance of healthy bacteria in your body, which works to fight the infection.

Adults with Compromised Immune Systems

An antifungal medication, such as itraconazole, is often prescribed to adults with compromised immune systems. This prevents the fungus from spreading and works to eliminate it from the body. The medication can come in a variety of forms, such as tablets, lozenges, or a liquid that you can swish in your mouth like mouthwash and then swallow.

If your infection is slightly more severe, you may receive an antifungal medication called fluconazole delivered intravenously in the hospital.

People with late-stage HIV might need a stronger medication, such as amphotericin B.

If your esophageal thrush has compromised your ability to eat, your doctor may discuss nutritional options with you. This can include high-protein shakes if you can tolerate them or alternative feeding options, such as a gastric tube in severe situations.


A baby may develop esophageal thrush from breast-feeding if the mother’s nipples are infected with thrush. In this case, your doctor will prescribe an antifungal medication to put on your breasts and another one to give to your baby orally.

If your child has had esophageal thrush, be sure to clean their bottles and pacifiers with a solution of equal parts vinegar and water. After, allow the pieces to air dry to prevent any fungus from growing.

Preventing Esophageal Thrush

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You can reduce your risk of developing esophageal thrush in the following ways:

  • Eat yogurt whenever you take antibiotics.
  • Treat vaginal yeast infections.
  • Practice good oral hygiene.
  • Go to your dentist for regular checkups.
  • Limit the amount of sugary foods you eat.
  • Limit the amount of foods you eat that contain yeast.

If you’re a nursing mother and you or your baby have been diagnosed with esophageal thrush, applying antifungal cream to your breasts can help reduce the likelihood that you will pass the condition back to your baby. You should also carefully clean any accessories your baby may use during feeding. These include breast pump supplies, bottles, and bottle nipples.

Even though those with HIV and AIDS are at greater risk for esophageal thrush, doctors rarely prescribe preventive antifungal medicines. The yeast could become resistant to treatments. If you have HIV or AIDS, you can reduce your risk of an esophageal thrush infection by taking prescribed antiretroviral therapy (ART) medications.

Future Health Complications

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The risk for complications after the development of esophageal thrush is higher in people with comprised immune systems. These complications include thrush that spreads to other areas of the body and an inability to swallow.

If you have a compromised immune system, it’s very important to seek treatment for thrush as soon as you notice symptoms. Thrush can easily spread to other parts of your body, including your:

  • lungs
  • liver
  • heart valves
  • intestines

By receiving treatment as quickly as possible, you can reduce the likelihood that thrush will spread.

Outlook for Esophageal Thrush

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Esophageal thrush can be painful. If it’s left untreated, it can become a severe and even life-threatening condition. At the first signs of oral thrush or esophageal thrush, talk to your doctor. Esophageal thrush is highly prone to spreading. The more areas of the body affected, the more severe the infection can be. Medications are available to treat esophageal thrush, including antifungal medicines. Prompt and careful treatment can reduce your pain and discomfort. 

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