When discussing yeast infection of the esophagus one needs to be aware that the yeast bug (Candida albicans) is a normal constituent of the oral flora including the esophagus.
In the early days of using Tetracycline for acne treatment it became apparent that antibiotics not infrequently caused yeast infection, particularly of the esophagus. Other factors are high blood sugar, and associated high sugar content of saliva, as with diabetics whose blood sugars are not well controlled. A weakened immune system (such as in leukemia, cancer or AIDS) can also lead to this.
Another factor can be the accumulation of food in a diseased esophagus (for instance in achalasia, a congenital disease) or in the scleroderma, which is an autoimmune disease. Sometimes there are yeast plaques at the pharynx, but if only the esophagus is affected, the only symptom may be some swallowing problem or feeding problem in a baby. X-rays of the esophagus may show some of the slightly raised plaques, but the definite diagnosis would be via an endoscopic procedure by a gastroenterologist or surgeon, called gastroscopy. The cultures of samples and specimens stained for fungi will help to make the diagnosis. Here are pictures of yeast infections (thanks to www.yeastinfectionadvisor.com for this link) of the oral cavity and the esophagus.
Treatment
In simple cases nystatin is given as suspension, where 1 teaspoon contains 500,000 units, and this is administered four times daily for 7 to 14 days.
However, in more severe cases the yeast bugs may be too deeply entrenched in the esophagus, so that the suspension cannot reach it. In these cases it needs to be coupled with oral medication such as ketoconazole or fluconazole. Alternatively amphotericin B, given intravenously, may have to be administered. The doctor may want to repeat the endoscopy procedure at the end of the treatment schedule to verify that the chronic esophagus yeast infection has indeed resolved.
References:
1.The Merck Manual, 7th edition, by M. H. Beer s et al., Whitehouse Station, N.J., 1999. Chapter 158.
2.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 113.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 164.
4.David Heymann, MD, Editor: Control of Communicable Diseases Manual, 18th Edition, 2004, American Public Health Association.
