Candida esophagitis

by Jason Wasserman MD PhD FRCPC
June 28, 2023

What is Candida esophagitis?

Candida esophagitis is a medical condition caused by infection of the esophagus by the fungus Candida. The infection leads to inflammation which damages tissue on the inside of the esophagus. Other names for this condition include esophageal candidiasis and thrush.

Candida esophagitis
Candida esophagitis. This picture shows a superficial biopsy of squamous epithelium with neutrophils scattered throughout the epithelium.

What causes Candida esophagitis?

Candida esophagitis is caused by infection of the tissue on the inside of the esophagus with the fungus Candida. Most infections are caused by Candida albicans or Candida tropicalis.

Who is at risk for developing Candida esophagitis?

People who have a weakened immune system are more likely to develop Candida esophagitis. Candida esophagitis is also more common in people with diabetes mellitus, esophageal motility disorders, and the elderly. Corticosteroids and antibiotic use also increase the risk of developing Candida esophagitis.

What are the symptoms of Candida esophagitis?

The most common symptoms of Candida esophagitis are difficulty swallowing and pain when swallowing food or liquids.

How is Candida esophagitis diagnosed?

The diagnosis of Candida esophagitis can be made after your doctor examines the inside of your esophagus with a camera called an endoscope. During this examination, a white or grey discoloration may be seen on the inside of the esophagus. Small samples of tissue will be removed from the abnormal area in a procedure called a biopsy and the tissue will be sent to a pathologist for examination under the microscope.

What does Candida esophagitis look like under the microscope?

The cells that normally cover the inside of the esophagus are called squamous cells and they form a barrier called the epithelium. In Candida esophagitis, the micro-organisms will be seen on the surface of the epithelium and in between the squamous cells. Cells from the body’s immune system, including a large number of neutrophils, respond to the presence of micro-organisms with a process called acute inflammation. Damaged or dying squamous cells are often seen in the area of acute inflammation. These cells may be described as squamous or necrotic debris.

What other tests may be performed to confirm the diagnosis?

Your pathologist may perform special stains including Grocott and PAS-D which make it easier to see the micro-organisms within the tissue.

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