Esophageal Thrush (Candida Esophagitis)

Written by April Kahn | Published on August 7, 2012
Medically Reviewed by George Krucik, MD

What is Esophageal Thrush?

Esophageal thrush is a yeast infection of the throat, and is also known as oral candidiasis, or oropharygeal candidiasis.

Fungi in the family Candida cause esophageal thrush. Although there about 20 species of Candida that can cause the condition, it is usually caused by one species in particular: Candida albicans.

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 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.

If you are healthy, it is unlikely that you will develop this condition. People with compromised immune systems—such as those with HIV and AIDS or cancer—and the elderly are at a higher risk. According to the CDC, 20 percent of all cancer patients develop the condition (CDC).

People with diabetes mellitus are also at a higher risk of developing esophageal thrush. If you have diabetes mellitus, there is an excessive amount of sugar present in your saliva. The sugar allows the yeast to thrive.

Babies who are born vaginally may develop oral or esophageal thrush if their mother had a yeast infection when she delivered. Infants can also develop thrush from breastfeeding, if their mother’s nipples are infected.

Who is at Risk?

Esophageal thrush can affect people at any age. However, certain risk factors make some people more likely to develop this condition.

You are more at risk if you:

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

Identifying the Symptoms of Esophageal Thrush

The symptoms of esophageal thrush include:

  • white lesions on the lining of your throat (esophageal lining)
  • cottage cheese-like lesions
  • pain in your esophagus and mouth
  • slight bleeding in the lesions if they’re scraped
  • dry mouth
  • pain when swallowing
  • difficulty swallowing
  • nausea
  • vomiting
  • weight loss
  • a feeling of chest pain

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

Testing for and Diagnosing Esophageal Thrush

If your doctor suspects you might have esophageal thrush, he or she 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 lives in the mouth, seeing the fungus on a culture may not be enough to indicate esophageal thrush. Your doctor may 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 may also be lowered into your stomach or intestines to check the extent of the infection.

Treating Esophageal Thrush

Treatment for esophageal thrush has two goals—to kill the fungus and to prevent it from spreading further.

Healthy Adults

If you have esophageal thrush but are otherwise healthy, your doctor may recommend that you eat yogurt or to take acidophilus to treat the infection. These treatments do not have fungus-killing abilities, 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 both 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 the thrush 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.

Infants

Babies may develop esophageal thrush from breastfeeding, if the mother’s nipple is infected with thrush. In this case, your doctor will prescribe the mother an antifungal medication to put on her breasts, and another one to give to the baby orally.

If your child has had esophageal thrush, be sure to clean his or her bottles and pacifiers with an equal parts vinegar and water solution. After, allow them to air dry to prevent any fungus from growing.

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
  • have regular checkups with your dentist
  • limit your consumption of sugary foods
  • limit your consumption of foods that contain yeast

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
  • inability to swallow
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