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Esophageal Thrush (Candida Esophagitis)

What is esophageal thrush?

Esophageal thrush is a yeast infection of the esophagus. The condition is also known as esophageal 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.

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Causes

How does esophageal thrush develop?

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 organisms 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.

Risk factors

Who is at risk?

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. Having AIDS is the most common underlying risk factor. According to the Centers for Disease Control and Prevention (CDC), 20 percent of all people with cancer 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. More importantly, uncontrolled diabetes also hurts your immune system, which allows for candida to thrive.

Babies who are born vaginally can develop oral thrush if their mothers had a yeast infection during delivery. Infants can also develop oral thrush from breastfeeding if their mother’s nipples are infected. Developing esophageal thrush this way is uncommon.

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
  • use a steroid inhaler for conditions like asthma
  • have a dry mouth
  • eat lots of sugary foods
  • have a chronic disease
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Symptoms

Identifying the symptoms of esophageal thrush

The symptoms of esophageal thrush include:

  • white lesions on the lining of your esophagus that may look like cottage cheese and may bleed if they’re scraped
  • pain or discomfort when swallowing
  • dry mouth
  • 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 and on surface of the tongue
  • white lesions on the roof of your mouth, tonsils, and gums
  • cracking in the corner of your mouth

Breastfeeding 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.

Diagnosis

Esophageal thrush: Testing and diagnosis

If your doctor suspects you might have esophageal thrush, they will do an endoscopic exam.

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.

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Treatment

Treating esophageal thrush

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

Esophageal thrush warrants systemic antifungal therapy, and an antifungal medication, such as itraconazole, will likely be prescribed. 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. Most importantly, treating the HIV is important for controlling the esophageal thrush.

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.

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Prevention

Preventing esophageal thrush

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.

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.

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Complications

Future health complications

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

Outlook for esophageal thrush

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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