Thrush esophagitis B37.81

Acute or chronic infection of the oesophagus by Candida species.

The multi-layered squamous epithelium protects the oesophagus relatively well against viral, bacterial or mycotic infections. Candidiasis of the esophagus is the most common form of infectious esophagitis. Immunocompromised patients are most at risk, including patients with HIV / AIDS, leukaemia, diabetes mellitus and patients who received corticosteroids (in tablet form, but also inhaled for bronchial asthma) over a longer period of time, as well as patients undergoing radiation and/or chemotherapy (Mohamed AA et al. 2019). Another group includes those patients who frequently used antibiotics. Furthermore, patients with oesophageal motility disorders (e.g. systemic scleroderma) are preferred.

Mild infections often remain asymptomatic. Patients with pronounced findings complain of dysphagia (difficulty swallowing) accompanied by retrosternal pain (odynophagia). During physical endoscopic examination, whitish plaques are found on the mucous membrane. These are often combined with oral candidiasis (oral thrush) (indicator symptoms).

The endoscopic examination (esophagoscopy) is the best method of examination to diagnose this disease. Endoscopically, the extent and intensity of the disease can be determined and materials (biopsy, smear) can be taken for histological (PAS staining) and microbiological examination (culture).

It is important to separate the candidiasis of the esophagus from other forms of infectious esophagitis: viral esophagitis(cytomegalovirus, herpes simplex virus - possible detection by PCR technique!), gastroesophageal reflux disease, drug-induced esophagitis, radiation-induced esophagitis; esophageal lesions, eosinophilic esophagitis.

The treatment is carried out by systemic triazole antimycotics(Fluconazole 400mg p.o./day, maintenance therapy until healing with 200mg/day, which are administered orally in a defined course. Local treatment with Amphotericin B lozenges is at best additive (Cornely O et al. (2019).

Remark: In case of herpes simplex infection the administration of acyclovir is indicated, in case of cytomegalovirus infection ganciclovir is indicated.

Elimination or treatment of the underlying causes!

With the exception of a few complications such as necrotizing candidiasis, fistula formation, sepsis, the prognosis for candidiasis of the esophagus is good. Mild forms heal spontaneously.

The adherent whitish lesions cannot be washed away with water from the rinse. An oro-pharyngeal thrush is often an indicator disease for a thrush esophagitis.

1. Cornely O et al (2019) esophagitis. In: Hof H, Schlüter D, Dörries R, ed. dual series Medical Microbiology. 7th, completely revised and extended edition. Stuttgart: Thieme Publishing House Stuttgart S 649
2. Hoversten P et al (2018) Infections of the esophagus: an update on risk factors, diagnosis, and management. Dis esophagus 31: doi: 10.1093/dote/doy094.
3. Kondo T et al (2017) Candida esophagitis. N Engl J Med 376:1574.
4. Mohamed AA et al (2019) Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. Can J Gastroenterol Hepatol 20:3585136.