Esophageal Candidiasis

Overview

Esophageal candidiasis (say: uh-sof-uh-JEE-ul kan-dih-DY-uh-sis) is a fungal infection of the esophagus — the food pipe, the tube that carries food from your mouth to your stomach. It happens when a yeast called Candida, which normally lives harmlessly in your mouth and gut, grows too much in the food pipe. This causes swelling and soreness, and it can make swallowing painful or difficult. It is sometimes called esophageal thrush, or Candida esophagitis. It is treatable, and most people feel much better once it is properly treated.

It is not common in people who are generally healthy. It is seen much more often in people whose immune system is weakened, so doctors often look for an underlying reason when they find it.

It can affect anyone, but it is most often seen in people with a lowered immune system (for example people living with HIV, people having chemotherapy, or people taking medicines that suppress immunity after an organ transplant), people with poorly controlled diabetes, people using inhaled steroid medicines for asthma or lung disease, people who have recently taken a long course of antibiotics, people with dry mouth or poorly fitting dentures, and people who are frail, very young or very old.

Symptoms

Common symptoms

• Pain or a burning feeling when swallowing food or drink
• A feeling that food is sticking or getting stuck in the chest or throat
• Pain behind the breastbone (the bone in the middle of your chest)
• White or creamy patches on the tongue, inner cheeks, roof of the mouth or throat
• A sore mouth, sore throat or unusual taste
• Eating less than usual, leading to weight loss
• Feeling sick, or a reduced appetite

Symptoms in children

• Refusing feeds or crying during feeding
• Dribbling more than usual
• White patches in the mouth that do not wipe off easily
• Being irritable or unsettled around feeding times
• Poor weight gain or fewer wet nappies
• In older children, complaining that it hurts to swallow or that food feels stuck

Symptoms in older adults

• Symptoms may be mild or vague, such as eating less or feeling generally unwell
• Weight loss or dehydration that is noticed before any mouth soreness
• New or worsening confusion in a frail person, which can be a sign of not eating or drinking enough
• Problems with dentures that no longer fit comfortably
• A dry mouth that makes swallowing harder

Causes

Main causes

• Overgrowth of Candida yeast, a fungus that normally lives in small amounts in the mouth and digestive tract without causing harm
• A drop in the body's immune defenses, which normally keep the yeast in check
• Changes in the mouth or throat, such as a dry mouth or a lower production of saliva, which usually helps wash yeast away
• Irritation or damage to the lining of the food pipe that gives yeast a place to grow

Risk factors

• A weakened immune system, for example from HIV, chemotherapy, organ transplant medicines, or long courses of steroid tablets
• Poorly controlled diabetes
• Using inhaled steroid medicines for asthma or lung disease, especially without rinsing the mouth afterwards
• Recent or long courses of antibiotic medicines
• Dry mouth, which can be caused by some medicines or certain health conditions
• Wearing dentures, particularly if they fit poorly or are not cleaned regularly
• Smoking
• Poor nutrition or significant weight loss
• Being very young or frail and older
• Medicines that reduce stomach acid, when used long term

When to see a doctor

See a doctor urgently if:

• You cannot swallow properly, or swallowing is becoming harder
• You have chest pain, or you are bringing up blood
• You have a high temperature with severe mouth or throat soreness
• You are not able to keep fluids down, or you feel dizzy and light-headed
• You have a weakened immune system and develop any new swallowing or mouth symptoms

Book a routine appointment if:

• Pain when swallowing that has lasted more than a few days
• White patches in your mouth that do not clear with good mouth care
• A feeling that food is sticking in your chest or throat
• You are eating less and losing weight without trying
• You use an inhaled steroid and keep getting mouth or throat symptoms

Diagnosis

A doctor will usually start by asking about your symptoms, your medical history and any medicines you take, and will look inside your mouth and throat with a light. If the picture is typical, they may feel confident enough to start treatment and see how you respond. If symptoms are unclear, severe, or keep coming back, they may refer you for a camera test of the food pipe, or arrange other tests to look for an underlying cause.

Tests that may be done

• A physical examination of your mouth and throat with a light
• Endoscopy (gastroscopy) — a thin, flexible tube with a tiny camera is passed gently down your throat so the doctor can look at the lining of the food pipe; you are usually offered medicine to make you relaxed and comfortable
• A small sample or brushing taken during endoscopy, which can be checked in a laboratory to confirm the yeast
• Blood tests, such as a blood count or a sugar test, to look for conditions that make infection more likely
• Depending on your history, tests to check your immune system or to look for an underlying cause

What to expect at your appointment

Most people start with a simple consultation and examination. If you need an endoscopy, you will usually be told not to eat or drink for a few hours beforehand. The test itself takes only a short time, you can usually go home the same day, and your throat may feel a little sore afterwards. Results from samples can take a few days, and your doctor will explain what they found and what happens next.

Treatment

Esophageal candidiasis is treated with antifungal medicine prescribed by a doctor, together with steps to deal with any underlying reason the yeast has grown. The aim is to clear the infection, ease swallowing, and keep it from coming back.

Self-care at home

• Choose soft, cool or room-temperature foods that are easy to swallow, such as soups, yoghurt, mashed food, scrambled eggs and smoothies
• Sip fluids regularly through the day so you stay hydrated
• Avoid very hot drinks, alcohol, and very spicy, salty or acidic foods while your throat is sore
• Keep your mouth clean: brush gently with a soft brush and rinse with plain water or a mild salt-water rinse
• If you use an inhaled steroid, rinse your mouth with water and spit it out after each dose
• If you wear dentures, take them out at night and clean them properly
• Ask a pharmacist about suitable pain relief and about lozenges or sprays that are gentle on a sore mouth
• Avoid smoking, as it slows healing

Medical treatments

Doctors treat this with antifungal medicines — medicines that target fungal infections. These are usually given as tablets, capsules, or as a liquid that is swallowed or held in the mouth, depending on the situation. How long you take them depends on how severe the infection is and on your general health. Your doctor may also adjust or review other medicines you take, treat a condition that is making infection more likely, and, if you use an inhaled steroid, check your inhaler technique. Always take antifungal medicines exactly as prescribed and finish the course, even if you feel better early. Do not use leftover medicines or someone else's medicine.

When is surgery considered?

Surgery is not needed for esophageal candidiasis itself. In rare cases where an untreated infection leads to scarring or narrowing of the food pipe, a specialist may discuss procedures to widen it.

Living with this condition

Most people improve within days of starting the right treatment. While you recover, it helps to eat little and often rather than large meals, keep drinks close by, and rest. If you have a long-term condition that makes infection more likely, your care team may check in with you more regularly. Keep a note of your symptoms so you can tell your doctor what has changed.

Lifestyle tips

• If you have diabetes, keep your blood sugar as stable as you can and attend your regular reviews
• Stop smoking if you can — your doctor or pharmacist can offer support
• Limit alcohol while you are recovering
• Keep up good mouth care, including regular dental check-ups
• Make sure your dentures fit well and are cleaned daily
• Eat a balanced diet with enough protein and fluids to support healing
• Take medicines exactly as prescribed and ask your doctor or pharmacist before starting anything new

Diet and exercise

There is no special diet that cures this infection, but soft, gentle foods and plenty of fluids help while your throat heals. Build back to your normal diet as comfort allows. Gentle activity such as short walks is fine and can help you feel better, but rest when you are tired. If you are losing weight or struggling to eat, ask your doctor for advice — a dietitian can help.

Mental health and emotional wellbeing

Painful swallowing and a mouth infection can be draining, and it is normal to feel worried, frustrated or low, especially if you are already managing another health condition. These feelings usually ease as you recover. If low mood, anxiety or worry about eating is affecting your daily life, tell your doctor — support is available and it is a sensible part of your care, not a sign of weakness. If you ever feel you are in crisis or having thoughts of harming yourself, contact your local emergency number or a local crisis support service straight away, or reach out to someone you trust and ask them to stay with you.

Prevention

It cannot always be prevented, but you can lower the chances of it happening or coming back. If you use an inhaled steroid, rinse your mouth with water and spit it out after every dose — this is one of the simplest and most effective steps. Keep long-term conditions such as diabetes as well controlled as possible, keep your mouth and dentures clean, avoid smoking, and only use antibiotics when they are genuinely needed. If you have a weakened immune system, tell your doctor about any new mouth or swallowing symptoms early.

Screening programmes

There is no routine screening programme for esophageal candidiasis. Doctors do look for it when someone has typical symptoms or is in a higher-risk group, and people with conditions that weaken the immune system have regular check-ups that include looking in the mouth.

Complications

If left untreated

• Ongoing pain and difficulty eating, which can lead to weight loss and poor nutrition
• Dehydration from not drinking enough
• Sores or ulcers in the food pipe, which can occasionally bleed
• Rarely, scarring or narrowing of the food pipe that makes swallowing harder
• In people with a severely weakened immune system, the infection can spread beyond the food pipe into the bloodstream, which is serious and needs urgent treatment

Long-term outlook

The outlook is generally good. With the right antifungal treatment, most people notice a clear improvement within a few days and recover fully. If the infection comes back, it is usually because the underlying reason — such as a weakened immune system, diabetes or an inhaled steroid — has not yet been addressed, and treating that usually helps. Seeing your doctor early and following the treatment plan gives you the best chance of a smooth recovery.

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