Summary about Disease
Fungal esophagitis is an infection of the esophagus, the tube that carries food from your mouth to your stomach, caused by a fungus, most commonly Candida albicans. It leads to inflammation and discomfort, potentially making swallowing difficult and painful. While anyone can get it, it's more common in individuals with weakened immune systems.
Symptoms
Painful swallowing (odynophagia)
Difficulty swallowing (dysphagia)
Chest pain
Food getting stuck in the esophagus
Nausea
Vomiting
Sore throat
Heartburn or acid reflux
Sometimes, there might be no symptoms.
Causes
The most common cause is an overgrowth of Candida albicans. Other less common fungal causes include *Trichosporon*, *Aspergillus*, or other Candida species. Factors increasing risk include:
Weakened immune system (HIV/AIDS, cancer, organ transplant recipients)
Diabetes
Use of inhaled corticosteroids (asthma/COPD)
Use of antibiotics
Use of proton pump inhibitors (PPIs)
Dysmotility disorders of the esophagus
Radiation therapy to the chest
Medicine Used
Antifungal medications are the primary treatment. Common options include:
Fluconazole: An oral antifungal medication.
Itraconazole: Another oral antifungal option.
Voriconazole: Used for more resistant infections.
Posaconazole: Used for more resistant infections.
Amphotericin B: An intravenous antifungal (used for severe or resistant cases).
Nystatin: Although available, it is not commonly used for esophagitis due to poor absorption.
Is Communicable
Fungal esophagitis itself is generally not communicable in the sense of being directly contagious from person to person through casual contact. However, the Candida fungus is naturally present in/on many people's bodies. An overgrowth leading to esophagitis is usually due to individual immune system compromise, rather than acquisition from another person.
Precautions
Maintain good hygiene: Regular hand washing.
Rinse mouth after using inhaled corticosteroids: To prevent oral thrush (which can spread to the esophagus).
Manage underlying conditions: Control diabetes, HIV, or other conditions that weaken the immune system.
Avoid unnecessary antibiotic use: Antibiotics can disrupt the balance of microorganisms in the body.
Review medications: Discuss with your doctor if PPIs or other medications are contributing to the problem.
Properly clean medical devices: If using medical devices (like inhalers).
How long does an outbreak last?
With appropriate antifungal treatment, most cases of fungal esophagitis resolve within 1 to 3 weeks. More severe or resistant infections might take longer. Recurrence is possible, especially in individuals with ongoing immune compromise.
How is it diagnosed?
Endoscopy: A thin, flexible tube with a camera is inserted into the esophagus to visualize the lining and take biopsies. This is the most accurate method.
Biopsy: A small tissue sample taken during endoscopy is examined under a microscope to identify the fungus.
Barium swallow: X-rays are taken after drinking a barium solution to visualize the esophagus (less common, primarily used to rule out structural issues).
Empiric therapy: In some cases, if the symptoms and risk factors strongly suggest fungal esophagitis, a doctor might start antifungal medication without an endoscopy, and monitor for improvement. If symptoms don't improve, an endoscopy is then performed.
Timeline of Symptoms
The timeline of symptoms can vary.
Early stages: Mild discomfort or difficulty swallowing.
Progression: Increased pain, more difficulty swallowing, chest pain, food sticking.
Severe cases: Severe pain, significant difficulty swallowing, potential for dehydration and malnutrition. The onset can occur rapidly, over a few days to a week.
Important Considerations
Fungal esophagitis is often a sign of underlying immune system problems. Further evaluation for immune deficiency may be warranted.
Recurrent infections should be investigated to identify and address the underlying cause.
If you experience difficulty swallowing, it's important to seek medical attention promptly, as this can lead to dehydration and malnutrition.
Drug interactions should be checked, particularly when using azole antifungals.
Adherence to the prescribed antifungal regimen is crucial for successful treatment.