Favored by conditions such as for example the improper use of antibiotics, immunosuppression and diabetes mellitus, esophageal candidiasis is typically responsible for: whitish plaques in the mucosa of the esophagus, pain when swallowing, nausea, vomiting, difficulty in eating and weight loss.
For the diagnosis of esophageal candidiasis, endoscopy of the esophagus is decisive.
The presence of esophageal candidiasis requires the use of drug therapy based on antifungals.
Esophageal candidiasis is also known by the terms "candida of the esophagus" and "candida esophagitis".
For further information: Intestinal Candida: What "is For more: Oral Candidiasis: What" is For more: Vaginal Candida: What "is
Brief reminder of what Candida is
Candida (or candidiasis) is a "fungal infection (or mycosis) caused by the fungus Candida albicans. This fungus is naturally present in the human body; in particular, it loves to live in humid and warm environments, such as the mouth, throat, esophagus, gastrointestinal tract and genitals (vagina, in women, and glans, in men).
LIKE CANDIDA ALBICANS CAUSE THE CANDIDA
Candida albicans it is, in fact, a fungus that is generally harmless to humans, as the so-called "good bacteria" constituting the bacterial flora and the immune system prevent its pathological proliferation.
However, when these two control systems fail, Candida albicans begins to multiply intensively, giving rise to the condition known as candida or candidiasis.
Mushrooms that behave like Candida albicans - that is, who take advantage of a difficult situation on the part of the host - are called opportunistic mushrooms.
Scientific classification of Candida albicans
Candida albicans it is a saprophytic fungus (that is, it feeds on decaying material), belonging to the saccharomycetes family. Saccharomycetes are particular unicellular organisms, which live in colonies and which fall into the category of so-called yeasts (exactly as Saccharomyces cerevisiae, the yeast used for bread).
like Candida albicans;Generally, immunosuppression is a typical problem of: those suffering from diseases such as AIDS or cancer (which undermine the integrity of the immune system), those taking immunosuppressive or chemotherapy drugs (these are drugs that lower the immune system) and the elderly (for physiological reasons);
These circumstances are followed by:
- Presence of a dental prosthesis;
- Make use of inhaled corticosteroids for asthma;
- Eating large amounts of sweet foods
- To smoke;
- Presence of a chronic disease, such as kidney failure.
It should be noted that, although it happens very rarely, even people who are in excellent health and do not fall into any of the aforementioned risk categories can develop esophageal candidiasis.
Neonatal Esophageal Candidiasis: the Causes
Babies born with vaginal birth to women suffering from esophageal candidiasis could acquire the latter from their mother; in such situations, esophageal candidiasis is more properly known as neonatal esophageal candidiasis.
Epidemiology
Esophageal candidiasis is rare in healthy people; on the other hand, it is quite common in people with cancer or AIDS and in individuals taking chemotherapy or immunosuppressants.
According to reports from the US institute known as Centers for Disease Control and Prevention (CDC), 20% of people with cancer develop esophageal candidiasis.
of the esophagus, of characteristic white plaques, similar to cottage cheese and prone to bleeding, if scraped; in addition, it determines:- Pain or discomfort when swallowing
- Nausea;
- He retched;
- Difficulty eating and weight loss. They are a direct consequence of painful swallowing;
- Chest pain.
Associated Diseases
Esophageal candidiasis is very often associated with oral candida; also known as oral thrush or thrush, oral thrush is the fungal infection that results from the uncontrolled proliferation of Candida albicans at the level of the oral cavity and pharynx.
Oral candida occurs with whitish, milky, punctate, lenticular or confluent plaques on the tongue, palate and pharynx, and with symptoms such as burning in the mouth, difficulty in swallowing and lack of perception of flavors.
Esophageal candidiasis in a person who is in excellent health
In those rare cases where it affects a healthy, healthy person, esophageal candidiasis is usually asymptomatic.
Complications
In the presence of immunosuppression or particular conditions (e.g. diabetes), esophageal candidiasis can degenerate into a systemic condition, known as invasive candidiasis (or invasive candida).
Invasive candida is the infection resulting from the fungus passing through the blood Candida albicans (fungemia or funghemia) and its spread to important organs, such as the heart (endocarditis), the brain (encephalitis), the lungs (pneumonia), the liver (hepatitis), the eyes (endophthalmitis) or the bones (osteomyelitis).
Invasive candida can be fatal for the patient, therefore it represents a "medical emergency, which needs immediate help.
Factors favoring invasive candidiasis:
- AIDS;
- Taking chemotherapy or immunosuppressants;
- Diabetes mellitus;
- Dialysis for acute renal failure;
- Use of the central venous catheter.
When to see a doctor?
An individual should contact their primary care physician when they fall into a risk category for esophageal candidiasis and develop the classic symptoms of the condition - pain when swallowing.
of the patient (anamnesis) are important, but not sufficient; the diagnostic confirmation of candida in the esophagus, in fact, requires the use of esophageal endoscopy.It should be noted that, in the presence of a suspected esophageal candidiasis, before resorting to endoscopy of the esophagus, doctors tend to prescribe the patient a course of antifungal treatments, to see if the symptoms improve or not: any improvement in symptoms excludes the execution of the endoscopic examination, while the persistence of the disturbances makes it necessary.
To justify this approach is the fact that, as reported in the next section, esophageal endoscopy is a minimally invasive procedure.
What is Esophageal Endoscopy?
Esophageal endoscopy is the instrumental examination which allows to visualize the internal anatomy of the esophagus, through the introduction, starting from the mouth, of a tubular instrument equipped with a camera and light source, the name of which is endoscope.
The endoscope is in fact a probe connected to an external monitor, onto which it projects what is detected by its camera.
Esophageal endoscopy involves sedation of the patient, in order to introduce the endoscope into the digestive system without problems.
Due to the use of sedation and the introduction of endoscopy into the digestive system, esophageal endoscopy is one of the minimally invasive procedures.
esophageal involves drug therapy based on antifungals, with the aim of eliminating the fungal colony responsible for the infection.
Antifungals are drugs with a specific anti-fungal power.
If esophageal candidiasis significantly affects the ability to eat, the therapy also includes a diet plan ad hoc and the use of particular methods of nutrition.
Medicines for Esophageal Candidiasis
The antifungal drugs most used in the presence of esophageal candidiasis are fluconazole l "itraconazole; belonging to the category of triazoles, fluconazole and itraconazole act against some enzymes that fungi such as Candida albicans they use to reproduce and survive (therefore they destroy molecules essential for the reproduction of Candida albicans).
If fluconazole and itraconazole are ineffective, drug therapy turns to amphotericin B, a polyene macrolide, or capsufungin, an echinocandin.
As regards the route of administration of the aforementioned drugs, this varies according to the severity of the infection: for mild-moderate infections, it is orally via capsules or tablets; for severe infections, however, it is intravenously via injection.
PHARMACOLOGICAL THERAPY WHEN ORAL CANDIDATION IS ASSOCIATED WITH ESOPHAGEA CANDIDOSIS
When esophageal candidiasis is associated with oral candida, the drug therapy based on fluconazole is enriched by the use of another medicine: nystatin.
PHARMACOLOGICAL THERAPY IN CASE OF INVASIVE CANDIDA OR AIDS
If esophageal candidiasis degenerates into invasive candida or affects an individual with AIDS, drug therapy involves the use of the aforementioned amphotericin B or capsufungin.
Duration of Pharmacological Therapy
Generally, the duration of drug therapy useful for counteracting esophageal candidiasis is around 21 days.
However, it is the treating physician who determines precisely how long the patient should take the antifungal drugs.
Diet
The diet for those who are unable to eat properly due to esophageal candidiasis involves the consumption of high-protein shakes or, in the most serious cases, the use of nasogastric tube nutrition.
, respect the doses prescribed by the attending physician and take lactic ferments;
