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Esophageal Thrush - Causes, Symptoms, and Treatment

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An esophageal infection that can be severe and life-threatening is called esophageal thrush. Read the article below to learn more about it.

Medically reviewed by

Dr. Ghulam Fareed

Published At March 21, 2023
Reviewed AtApril 21, 2023

What Is Esophageal Thrush?

Esophageal thrush is a severe yeast infection of the esophagus. This is also widely known as esophageal candidiasis. Candida family fungi are also responsible for causing thrush. Candidiasis of the esophagus is also called esophageal candidiasis. This condition is the most common infection in individuals with HIV or AIDS.

What Are the Causes of Esophageal Thrush?

Fungi from the Candida family are detected as the main cause of infection. There are around 20 different species of Candida that are responsible for the cause of this condition but are mainly caused by Candida albicans. Foods that contain more sugars and fermented foods are the sources. Any fermented yeast drinks, alcoholic beverages, and dairy products can be a potential source of this species.

What Are the Risk Factors for Esophageal Thrush?

  • Individuals with weak immunity have more tendency to develop this condition. People who are diagnosed with HIV, AIDS, or cancer are at high risk of getting the infection. AIDS is the most common underlying risk factor for getting a Candida infection.

  • Individuals with diabetes are at high risk of developing esophageal thrush, especially in cases where sugar levels are not under control. Sugar allows yeast to thrive, and uncontrolled diabetes affects the immune system which in turn allows Candida to thrive.

  • Vaginally born babies are prone to develop thrush and are born to mothers who had a history of yeast infection. They can also develop the condition from breastfeeding. This can lead to oral thrush but esophageal thrush is uncommon in this state.

  • Other risk factors include smoking, wearing dentures, steroid inhalers, certain medications, dry mouth, and underlying chronic disease.

What Are the Sign and Symptoms of Esophageal Thrush?

The primary symptom of esophageal thrush is dysphagia, and difficulty in swallowing. Esophageal candidiasis involves the development of multiple white patches inside the esophagus. Other symptoms of esophageal thrush are:

  • Nausea.

  • Acid reflux.

  • Change in taste.

  • Pain while swallowing.

  • Burning and itching sensation in the back of the mouth and the throat.

  • Fever.

  • Chest soreness.

How Is the Diagnosis for Esophageal Thrush Done?

The esophageal thrush diagnosis is done by a check on the presenting symptoms, and sometimes the symptoms alone are enough to diagnose the condition. In some cases, samples of the patches in the mouth and esophagus are taken and sent to the laboratory for diagnosis. Testing is done to identify the causes of the patch.

In deep-severe infections of the esophagus, the healthcare providers may use an esophageal endoscopy for accurate diagnosis. This involves inserting a thin flexible illuminated tube into the throat through the mouth, inside the esophagus. In some cases, endoscopy is avoided if the symptoms get better by medication.

What Is the Treatment Provided for Esophageal Thrush?

Treatment of esophageal thrush involves the use of antifungal therapy. Esophageal thrush should always be treated by systemic agents and not topical agents. Commonly used medication to treat thrush is oral Fluconazole 200 to 400 mg per day for 14 to 21 days. If the individual cannot tolerate oral intake, intravenous Fluconazole 400 mg daily can be used.

Fluconazole 100 to 200 mg can be administered three times per week to suppress recurrent esophageal thrush. For patients who can tolerate oral intake, Fluconazole 400 mg daily can be used. Other medications like Micafungin, Itraconazole, Voriconazole and Amphotericin B can be used in individuals with refractory candida esophagitis. Also, Posaconazole can be used as a treatment.

What Are the Complications of Esophageal Thrush?

The complications of esophageal thrush spread quickly and can lead to serious complications. If the treatment is not provided or the given treatment fails the individual may develop:

  • Candida of organs, like the heart and the lungs.

  • Sepsis (a life-threatening condition).

  • Candidemia (candida infection of the blood).

  • Malnourishment and weight loss due to dysphagia.

Individuals with weak immunity develop very serious complications. Having a weak immune system may also make it more likely for the initial treatment to fail and this may lead trial of several different medicine combinations which works.

What Are the Home Remedies for Esophageal Thrush?

Home remedies in conjunction with medical treatment can help to heal infection more quickly. Home remedies include:

  • Probiotic-Rich Food: Foods like cottage cheese and yogurt contain probiotics that help the body recover. The healthy bacteria in these foods prevent the growth of thrush.

  • Gentian Violet: It is a dye made of coal tar. Apply it directly by swabbing over the thrush in the mouth but it should not be swallowed. It is a synthetic antifungal and antiseptic dye used for the treatment of thrush.

  • Probiotic Supplements: Probiotic-rich foods, and supplements can help to maintain healthy bacteria and prevent future thrush infection.

What Is the Differential Diagnosis of Esophageal Thrush?

The differential diagnosis of esophageal thrush are:

  • Herpes simplex virus (a condition caused by a virus, leading to the formation of sores around lips and genitals).

  • Cytomegalovirus (a viral infection caused by cytomegalovirus).

  • Pill-induced esophagitis (a condition in which esophageal mucosa gets injured by certain medications).

  • Radiation esophagitis ( inflammation of the esophagus due to exposed radiation).

  • Eosinophilic esophagitis (a chronic immune system diseased condition in which the white blood cells build up on the lining of the esophagus).

  • Bacterial esophagitis (endoscopically observable erythema, ulcers, and hemorrhage).

  • Gastroesophageal reflux disease (a diseased condition where bile and stomach acid irritate the esophagus).

Conclusion:

Esophageal thrush can be a severely painful life-threatening condition if it is left untreated. The individuals with a history of thrush along with issues like difficulty swallowing should consult a healthcare provider immediately. The most prevalent cause of esophagitis is esophageal thrush. The primary care provided should include medication compliance for a cure. As prolonged treatment is often ineffective, individuals should be checked for infectious diseases like HIV (Human immunodeficiency virus disease) or the individuals on HAART(Highly active antiretroviral therapy). Esophageal thrush can be treated with various forms of oral and intravenous antifungal medications. A very careful and prompt treatment can reduce pain and discomfort. Adopting a healthy lifestyle, improving oral hygiene and strengthening immunity prevents esophageal thrush from reoccuring.

Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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esophageal yeast infectionesophageal candidiasis
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