Symptoms of Candida Esophagitis
The primary symptoms of Candida esophagitis are dysphagia (difficulty swallowing) and odynophagia (painful swallowing), which are the cardinal manifestations of this condition. 1, 2
Common Symptoms
Primary symptoms:
- Dysphagia (difficulty swallowing)
- Odynophagia (painful swallowing)
- Retrosternal burning pain or discomfort
Secondary symptoms:
- Chest pain (may mimic GERD symptoms)
- Food impaction
- Altered taste
- Weight loss due to poor nutrition (in advanced cases)
- Fever (particularly in immunocompromised patients)
Compensatory Behaviors
Patients with Candida esophagitis often develop adaptive eating behaviors to manage their impaired esophageal function:
- Avoiding difficult-to-swallow food textures
- Drinking large volumes of water with meals
- Eating slowly
- Cutting food into smaller pieces
Clinical Presentation by Patient Population
Symptoms may vary depending on the patient's immune status and underlying conditions:
Immunocompromised Patients
- More severe symptoms
- Higher likelihood of extensive esophageal involvement
- May present with fever
- Symptoms may be accompanied by oral thrush
- Weight loss may be more pronounced
Immunocompetent Patients
- May have milder symptoms
- Isolated white spots at the esophageal opening without dysphagia or odynophagia may not require immediate intervention 2
Diagnostic Indicators
While symptoms are suggestive, definitive diagnosis requires:
- Endoscopic visualization of characteristic white plaques or nummular lesions
- These lesions appear as adherent white patches that cannot be washed away with water irrigation
- In severe cases, the plaques may carpet the entire esophagus 1
- Histopathologic demonstration of Candida yeast forms in tissue
- Culture confirmation of Candida species
Risk Factors
Understanding the risk factors helps identify patients at higher risk for Candida esophagitis:
- Immunosuppression (HIV/AIDS, particularly with CD4+ counts <200 cells/μL)
- Recent antibiotic use
- Local or systemic steroid use
- Malignancy
- Proton pump inhibitor use
- Advanced age
- Chronic alcohol use
- Chronic kidney disease
- Diabetes
- Esophageal motility disorders leading to stasis 1, 2
Clinical Course
If left untreated, Candida esophagitis can lead to:
- Recurrent pain contributing to weight loss
- Potential complications such as necrotizing esophagitis
- Rare but serious complications including fistula formation and sepsis 3, 4
Early recognition of symptoms is crucial for timely diagnosis and treatment with appropriate antifungal therapy, typically fluconazole 200-400 mg daily for 14-21 days 1, 2.