29th July 2023

Oesophageal candidiasis

A more serious manifestation, which may occur as a complication of oropharyngeal candidiasis, is generally only seen in immunocompromised patients, especially those with HIV and on chemotherapy.

Clinical features include dysphagia, pain on swallowing (odynophagia), and retrosternal pain; although it may be asymptomatic. Odynophagia is considered the hallmark feature, and oesophageal candidiasis should be considered in any immunosuppressed patient reporting this symptom.

The characteristic plaques generally cannot be visualised; hence, endoscopy is required, from which histological samples may be sent.

Systemic treatment should be given – oral fluconazole for a minimum of 2 weeks is first line, although it may need to be given IV if this cannot be tolerated. Itraconazole and voriconazole can be used as second line options.