Oesophageal Infections

Candidal Oesophagitis

This is a condition which commonly causes pain on swallowing. Candida is a fungus that is commonly found on the skin, in the gut and the surrounding environment. It does not usually cause significant problems for healthy people. Candidal oesophagitis often arises in patients who are very frail, such as those on intensive care units, those who take high dose inhaled steroids (such as people with asthma or COPD) or patients who are immunocompromised. Endoscopic appearances typically demonstrate patches of white plaques overlying inflamed mucosa.

Usually the infection can be treated with anti-fungal medication such as fluconazole, by due to the nature of the risk factors for acquiring the condition (frailty and inhaled steroid use) even when the fungus has been treated) often persist and the fact that candida is a common environmental organism it may recur and require re-treatment.

HIV testing should be considered in patients who develop oesophageal candida infection.

 

Viral Oesophagitis

Infections with a number of viruses may cause inflammation within the oesophagus. Such inflammation commonly causes central chest discomfort and pain on swallowing. Viral infection within the oesophagus is unusual in people who are otherwise in good health and viral oesophagitis is usually seen in patients who are immunocompromised, or taking drugs such as systemic steroids or immunosupressants.

The commonest viruses to affect the oesophagus are cytomegalovirus (CMV) and herpes viruses. Treatment depends on whether any risk factors can be identified (such as whether the patient is taking steroids or immunosuppression) and withdrawn and whether specific antivirals are appropriate to treat the precipitating viruses. (often antivirals such as acyclovir or ganciclovir)