Brief overview
- Treatment: Candida of the esophagus can be treated well with antifungal medication (antimycotics) (active ingredient usually fluconazole).
- Symptoms: Thrush esophagitis often causes hardly any symptoms. Sometimes it manifests itself as painful swallowing problems, a burning sensation behind the breastbone and/or nausea.
- Causes: Candida yeast fungi infest and inflame the mucous membrane of the esophagus.
- Risk factors: Drugs that suppress the immune system (immunosuppressants), other immune deficiencies, severe physical stress, structural changes in the oesophagus and impaired stomach acid production promote the disease.
- Examination: The doctor examines the esophagus and takes swabs from the mucous membrane.
What is thrush esophagitis?
In thrush esophagitis, the mucous membrane of the esophagus becomes inflamed due to an infection with yeast fungi. Thrush is the collective term for diseases caused by Candida yeast fungi. Esophagitis refers to inflammation of the esophagus.
The yeast Candida albicans most frequently inflames the esophagus. It is part of the normal oral flora, but can spread rapidly in susceptible individuals. Thrush esophagitis is rare in people with a well-functioning immune system.
How is thrush esophagitis treated?
Doctors can treat thrush esophagitis well with antifungal medication, so-called antifungals. They usually prescribe fluconazole tablets for a period of 14 to 21 days. If necessary, they also give infusions with the active ingredient, for example in hospital. The symptoms usually improve after a week of treatment.
Sometimes Candida fungi are resistant to fluconazole. In these cases, other antifungal agents are available (e.g. caspofungin or amphotericin B).
Doctors always treat the disease that weakens the immune system and promotes thrush esophagitis. Sometimes doctors only discover such a disease because thrush esophagitis has occurred inexplicably. If there is an HIV infection, for example, this must be treated quickly. Doctors treat damage to the esophagus with targeted interventions to prevent the recurrence of thrush esophagitis.
Home remedies for thrush esophagitis
Home remedies can at best supplement conventional medical treatment, but they cannot replace it. Talk to your doctor about how you can best support the treatment yourself.
What are the symptoms of thrush esophagitis?
Thrush esophagitis does not always cause symptoms and is therefore asymptomatic. In other cases it manifests itself as
- Difficulty swallowing (dysphagia),
- Pain when swallowing (odynophagia),
- burning behind the breastbone.
Other possible symptoms are pain in the upper abdomen, loss of appetite and nausea, which promotes weight loss. In severe cases, the mucous membrane bleeds and those affected regurgitate blood or have black stools.
A Candida infection is characterized by a whitish coating that forms on the mucous membranes. In some patients, this is already clearly visible in the mouth and throat. Whether the oesophagus is also affected, however, can only be seen during an oesophagoscopy.
How dangerous is thrush esophagitis?
Thrush esophagitis is easily treatable and those affected are usually symptom-free after one week with antifungal medication. The fungal infection of the esophagus is over after two to three weeks. If the cause of the infection is unclear, doctors look for it specifically. This is because Candida does not normally spread like this in healthy people.
Another problem: resistance. It is becoming increasingly common for individual active ingredients to no longer harm Candida. As a result, the first treatment may not help, Candida may continue to grow and spread. Doctors then switch to another active ingredient as quickly as possible. There are several alternatives for this, so that the treatment of thrush esophagitis is still successful.
How does thrush esophagitis develop?
Thrush esophagitis is caused by Candida fungi, which is why it is also referred to as Candida esophagitis. Candida are yeast fungi that can be found everywhere in the environment. The fungi live as part of the microbiome (“natural flora”) in the digestive tract without causing any problems. The immune system keeps them in check.
However, if the immune system is weak, Candida can get out of control and multiply rapidly. The yeast fungus then attacks the mucous membranes and inflames them. In humans, it is mainly the Candida species Candida albicans that causes diseases such as thrush esophagitis. Known non-albicans pathogens include Candida glabrata and Candida tropicalis.
Thrush esophagitis is not directly contagious. However, the causative Candida yeast fungi pass from one person to the next, for example when kissing, and colonize the mucous membranes. The disease itself only develops when the fungi are able to spread.
Drugs such as “cortisone” and other so-called immunosuppressants down-regulate the immune system. Not only tablets, but also sprays with “cortisone” (e.g. for COPD or asthma) can facilitate the spread of fungi. Chemotherapy, on the other hand, destroys immune cells and thus impairs the immune system.
Antibiotics can also promote thrush esophagitis. They attack bacteria in the natural mucosal flora (microbiome) and disrupt the balance there. This makes it easier for fungi to grow and spread.
Thrush esophagitis in diseases with a weak immune system
There are also some diseases that weaken the immune system and make it more susceptible to fungal infections. These include
- congenital immunodeficiencies
- HIV/AIDS
- Blood cancer and lymph gland cancer
- Diabetes mellitus
- malnutrition
Stress and emotional strain can also place a heavy burden on the immune system and promote thrush esophagitis.
Increased risk due to esophageal diseases
A weakened immune system is not always the cause of thrush esophagitis. Some diseases affect the oesophagus and impair its structure and function. This can weaken the mucous membrane and its local defenses. These diseases include, for example
- Protrusions (diverticula) and constrictions (strictures) of the oesophageal wall
- Altered stomach acid (possibly eliminates fewer germs)
- Achalasia, a rare disease in which the mobility of the oesophagus is impaired
- Nerve diseases that make swallowing difficult (e.g. after a stroke or with Parkinson’s disease)
How does the doctor diagnose thrush esophagitis?
Doctors diagnose thrush esophagitis with the help of an endoscopy of the esophagus. During this so-called esophagoscopy, they insert a tube with a camera through the mouth and examine the mucous membrane of the upper digestive tract.
Candidiasis is typically characterized by white plaque that can hardly be wiped or rinsed away. They are sometimes already visible in the mouth or throat. The mucous membrane may be very sensitive and bleed easily.
Doctors take swabs of these plaque deposits, which are then examined more closely in a laboratory. The yeast filaments can be clearly seen under the microscope. In some cases, small tissue samples are used to detect an infestation in the deeper layers of the mucous membrane. The laboratory can also use the swabs to check which antifungal agents are effective against thrush esophagitis.
