Esophageal Diseases Similar to Candidiasis: Comprehensive List
The most common infectious esophageal diseases besides candidiasis include herpes simplex virus (HSV), cytomegalovirus (CMV), and idiopathic ulcers, particularly in immunocompromised patients. 1
Infectious Esophageal Diseases
Viral Infections
- Herpes simplex virus (HSV) esophagitis - presents with shallow ulcers visible on endoscopy 1
- Cytomegalovirus (CMV) esophagitis - characterized by deep ulcerations, more common in severely immunocompromised patients 1
- Human papillomavirus (HPV) - can cause ulcerative lesions and papillomas in the esophagus 2
- HIV-associated idiopathic ulcers - seen specifically in HIV-positive patients 1
Fungal Infections
- Candida esophagitis - most common infectious esophagitis, presenting with white nummular lesions that cannot be washed off 3
- Other fungal infections - less common but can occur in severely immunocompromised patients 4
Bacterial Infections
- Acute bacterial esophagitis - less common but important to recognize in appropriate clinical settings 5
Inflammatory Esophageal Diseases
Immune-Mediated Conditions
- Eosinophilic esophagitis (EoE) - characterized by eosinophilic infiltration, presents with rings, exudates, furrows, and strictures 1
- Lymphocytic esophagitis - characterized by lymphocytic infiltration of the esophageal epithelium 1
- Hypereosinophilic syndromes (HES) - systemic condition with esophageal involvement that can mimic EoE 1
- Eosinophilic granulomatosis with polyangiitis (EGPA) - formerly known as Churg-Strauss syndrome 1
Dermatologic Conditions with Esophageal Involvement
- Pemphigus vulgaris (PV) - can present with erythema, red longitudinal lines, erosions, blisters, and ulcers 1
- Lichen planus (LP) - most common dermatologic condition affecting the esophagus, can present with isolated esophageal involvement 1
- Other bullous dermatoses - can involve the esophagus even without dermal manifestations 1, 5
Systemic Diseases with Esophageal Manifestations
- Crohn's disease - can cause esophageal ulcerations, more common in children than adults 1
- Scleroderma - causes esophageal dysmotility and reflux changes 1
- Systemic lupus erythematosus - can have esophageal involvement 1
- Mixed connective tissue disease - may affect esophageal function 1
- Sjögren's disease - can present with non-specific edema and stenoses 1
Medication and Treatment-Related Esophageal Diseases
- Medication-induced esophagitis (e.g., doxycycline) - typically presents with 1-2 well-marked ulcerations 1, 5
- Radiation-induced esophageal injury - in patients with history of radiation therapy to chest 3
- Post-COVID dysmotility/achalasia - emerging condition following COVID-19 infection 1
Motility Disorders
- Achalasia - characterized by impaired relaxation of lower esophageal sphincter 1
- Diffuse esophageal spasm - abnormal contractions of the esophagus 1
- Other esophageal motility disorders - can be diagnosed with manometry 1
Diagnostic Considerations
For accurate diagnosis of these conditions:
- Endoscopy with biopsy is the gold standard for most infectious and inflammatory conditions 1
- Biphasic esophagram is more accurate than single-contrast for detecting ulcers or plaques associated with infectious esophagitis 1
- High-resolution esophageal manometry is essential for diagnosing motility disorders 1
- Direct immunofluorescence (DIF) is diagnostic for dermatologic conditions like pemphigus vulgaris 1
Treatment Approaches
Treatment varies by condition:
- For candidiasis and other fungal infections: fluconazole 200-400 mg daily for 14-21 days 1, 6
- For viral infections: acyclovir for HSV and ganciclovir/foscarnet for CMV 4
- For eosinophilic esophagitis: proton pump inhibitors, swallowed topical corticosteroids, or elimination diets 1
- For dermatologic conditions: condition-specific immunosuppressive therapy 1
- For motility disorders: endoscopic therapy such as dilation, botulinum toxin injection, or myotomy 1
Recognizing these various esophageal conditions is crucial for appropriate management and improving patient outcomes.