Oesophageal Candidiasis
Oesophageal candidiasis is invasive overgrowth of Candida along the oesophageal lining, most often during substantial immune suppression.
Key takeaways
- Painful swallowing, difficulty swallowing or retrosternal pain are typical, while visible oral thrush may be absent.
- HIV, chemotherapy, transplantation and systemic or high-dose inhaled corticosteroids increase risk.
- Systemic antifungal therapy is required because mouth rinses and lozenges do not reliably treat the oesophagus.
The listings below do not confirm Candida or define the safest antifungal; immune status, interactions and resistance matter.
Confirming the diagnosis
In a typical high-risk presentation, response to fluconazole may support diagnosis. Endoscopy with brushing or biopsy is important when symptoms are severe, atypical or unresponsive because herpes, cytomegalovirus, pill injury and cancer can look similar.
Treatment and underlying risk
Fluconazole is common first-line systemic treatment, while resistant or intolerant disease may need another azole or echinocandin. Liver function, QT interval and interactions require review. Persistent disease should prompt HIV testing or reassessment of immune suppression where appropriate.
When to seek urgent care
Seek urgent care for inability to swallow fluids, severe dehydration, vomiting blood, black stool, severe chest pain, fainting or marked illness during immune suppression.