Your pathology report for Candida esophagitis

by Jason Wasserman MD PhD FRCPC
July 25, 2025

Candida esophagitis is a fungal infection of the esophagus, the tube that carries food and liquids from your mouth to your stomach. This condition causes inflammation and damage to the lining of the esophagus. It is also known as esophageal candidiasis or simply esophageal thrush.

Candida is a type of fungus that normally lives on the skin and in the digestive tract without causing harm. However, under certain conditions, it can overgrow and cause an infection. When this happens in the esophagus, it can lead to pain, difficulty swallowing, and other symptoms.

What causes Candida esophagitis?

Candida esophagitis is caused by an overgrowth of Candida fungi in the esophagus. The two most common types of Candida responsible for this infection are Candida albicans and Candida tropicalis. These fungi can infect the surface of the esophagus and, in more severe cases, invade deeper into the tissue.

Who is at risk for developing Candida esophagitis?

Candida esophagitis is more likely to occur in people who have a weakened immune system. This includes people living with HIV/AIDS, those undergoing cancer treatment, and individuals taking medications that suppress the immune system, such as corticosteroids or drugs used after organ transplantation.

Other risk factors include:

  • Diabetes mellitus.

  • Antibiotic use, which can disrupt the normal balance of microorganisms in the body.

  • Older age.

  • Conditions that affect esophageal motility, such as achalasia or scleroderma.

  • Use of inhaled corticosteroids, especially without proper mouth rinsing afterward.

What are the symptoms of Candida esophagitis?

Symptoms can vary from person to person, but the most common include:

  • Pain or discomfort when swallowing (called odynophagia).

  • Difficulty swallowing (called dysphagia).

  • A feeling of food getting stuck in the chest or throat.

  • In some cases, people may also experience chest pain, nausea, or loss of appetite.

Some people may have no symptoms at all, especially in the early stages of infection.

How is Candida esophagitis diagnosed?

Candida esophagitis is usually diagnosed during a procedure called an upper endoscopy. During this test, your doctor uses a thin, flexible tube with a camera (called an endoscope) to examine the inside of your esophagus.

If Candida infection is suspected, the doctor may see white or grey patches or plaques on the esophageal lining. These areas may look irritated or inflamed. Small samples of tissue, called biopsies, will be taken from these patches and sent to a pathologist to confirm the diagnosis under the microscope.

What does Candida esophagitis look like under the microscope?

Under the microscope, a pathologist examines the tissue from your esophagus for signs of infection. The surface of the esophagus is normally covered by flat cells called squamous cells, which form a protective layer called the epithelium.

In Candida esophagitis:

  • The Candida organisms appear as yeast and branching hyphae (filament-like structures) growing on the surface of the epithelium and between the squamous cells.

  • The body responds with acute inflammation, which involves a large number of immune cells called neutrophils. These cells try to fight the infection but can also cause damage to the tissue.

  • The epithelium may show signs of injury, including cell death, which appears as necrotic or squamous debris.

These microscopic features help confirm the diagnosis of Candida esophagitis.

Candida esophagitis PASD
Candida esophagitis. Dark pink fungal microorganisms can be seen on the surface of the tissue in this PAS-D-stained section.

What other tests may be performed to confirm the diagnosis?

To help clearly identify the Candida fungus, your pathologist may perform special stains on the biopsy tissue:

  • Grocott’s methenamine silver stain (GMS) – Highlights fungal organisms in black against a green background.

  • PAS-D (periodic acid–Schiff with diastase digestion) – Stains fungal cell walls a bright pink color.

These stains make it easier to see the organisms, especially in early or mild infections, or when inflammation makes them harder to detect.

How is Candida esophagitis treated?

Treatment usually involves antifungal medications, such as fluconazole, which can be taken by mouth or given through a vein (IV) for more serious cases. Most people start to feel better within a few days of starting treatment.

If you have an underlying condition or risk factor, your doctor may recommend changes to your medication or treatment plan to help prevent the infection from coming back.

Questions to ask your doctor

  • Is my immune system the reason I developed this infection?

  • What treatment do I need, and how long should I take it?

  • Should I have follow-up tests to make sure the infection is gone?

  • Are there any steps I can take to reduce the risk of getting this infection again?

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