What is Esophageal Candidiasis?
is often referred to as an opportunistic infection of the esophagus. It is manifested when the esophagus is mostly attacked by the fungus or yeast known as Candida Albicans. However, it can also be caused by non albicans species too.
It is termed as an opportunistic infection because it does not affect healthy bodies. It chooses to attack immune compromised individuals as in cancer or AIDS patients. It is also known as Candidal esophagitis or monilial esophagitis.
It is very important to treat this condition at an early stage. Once this fungal infection reaches deep into the gastrointestinal tract and is left untreated, it can start affecting major organs and can even cause death. Mortality in end stage candida infection of the esophagus, when the fungus reaches the blood stream (also known as candida sepsis), is almost 70%.
Symptoms of Esophageal Candidiasis
- Odynophagia or painful swallowing.
- Difficulty in eating food and even swallowing liquids.
- Chest pain and a feeling of obstruction in chest.
- Weight loss due to inadequate intake of food.
- Nausea and Vomiting.
- Altered taste in mouth.
- Oral thrush is a condition where white velvety patches appear on tongue, mouth and lips. The candida in the esophagus can affect the mouth and oral cavity. Thrush can be extremely painful. The white sores get irritated and may be scraped causing bleeding. Chapped, sore corners of the lips as in angular cheilitis are also associated with it. This condition makes it rather difficult to eat food.
- It can cause fever when the fungus permeates in the blood stream.
<img src="http://digestion.ygoy.com/wp-content/uploads/2011/08/Advanced-Esophageal-Candidiasis.jpg" alt="Advanced Esophageal Candidiasis" title="Advanced Esophageal Candidiasis" style="float:right;margin-left:5px" /
How does the body react to this esophageal condition ?
This condition is associated with prolonged damage caused in the gastrointestinal tract. Conditions like GERD (Gastrointestinal Reflux disease), presence of viruses like herpes simplex virus and cytomegalovirus, esophageal lesions and ulcers makes one more susceptible to it. In healthy individuals, the intestinal wall can only absorb nutrients and allow them to enter the blood stream. In damaged intestinal walls, larger molecules from undigested food, fats and protein might get past the intestinal wall. They are treated by the body’s immune system as intruders and the body starts producing antibodies to combat them. This immune reaction is generally seen on encountering an allergen. Hence, the body starts being allergic to foods which previously caused no allergies. This malabsorption of nutrients from the intestinal tract causes a condition called the Leaky Gut Syndrome. Vitamin and mineral deficiencies are common in such a situation.
Who are at risk of getting this disease?
Immune compromised patients of cancer, HIV, diabetes, chronic infections etc. are mostle affected by this disease. Prolonged antibiotic therapy, corticosteroid treatments, radiation therapy and chemotherapy can also lead to immune suppression and bring about the said condition.
Diagnostic Tests to detect the condition
- Physical examination generally reveals the condition.
- Endoscopy can give a better picture and tissue samples can be scraped off the intestinal wall for analysis. Biopsy of the sample can confirm the presence of the yeast. However, endoscopy is recommended only when it is safe to do so.
Treatment of Esophageal Candidiasis
- Antifungal agents are used to treat the condition. They could be systemic or topical.
- Topical antifungal medications include nystatin and clotrimazole . They are administered directly on the sores or lesions in the form of a dissolving lozenge or in a liquid wash. However, if the individual has dry mouth syndrome (xerostomia) and cannot dissolve a lozenge in mouth then the therapy becomes ineffective.
- Among the more aggressive therapies, the first line of treatment is a single shot dose of flucanozole (Diflucan) (750mg).
- Oral triazoles like Itraconazole, Ketoconazole are an option too.
- The systemic ones include casmofungin and amphotericin. These are administered intravenously.
- The above drugs are extremely potent and can result in side effects like nausea, vomiting. upset stomach, diarrhea and elevated liver enzymes.