This is an oesophageal biopsy. What does it show?

How is it normally treated?

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Small numbers of Candida albicans contribute to our normal oral flora and may be present in the oesophagus in up to 20% of the population especially those treated with H2 blockers. Initially C.albicans adheres to the mucosa and proliferates but remains confined to the superficial mucosa. Colonisation may then progress to infection if systemic and local defences are inadequate in preventing invasion into deeper epithelial layers. Hence despite a small number of reports of oesophageal candidiasis in patients with no known underlying disease, it is more commonly associated with immunocompromised patients. The cause of immunocompromise is commonly due to malignancy, chemotherapy, corticosteroid treatment, immunosuppressive treatment after transplantation and acquired immune deficiency syndrome (AIDS). In fact oesophageal symptoms occur in up to half of all patients with AIDS and Candida accounts for 50% or more of these cases. Candida oesophagitis may also occur concurrently with herpes simplex virus or cytomegalovirus infection in those severely immunocompromised patients.

Accurate diagnosis of oesophageal candidiasis is established by endoscopy with directed brushings and biopsies. However with the appropriate clinical settings and characteristic endoscopic appearance of yellow-white patches resembling thrush and demonstration of hyphae and pseudohyphae on scrapings there is usually enough evidence to initiate therapy without histopathologic demonstration of the organisms invading the mucosa. The pseudomembrane that forms may become so extensive that it causes intraluminal protrusions and partial oesophageal obstruction.

Perforation of the oesophagus due to oesophageal candidiasis is in fact very rare however if perforation does occur it is usually in the lower two thirds of the oesophagus. Interestingly some of these patients may have had extensive oesophageal disease and been almost asymptomatic as a result of denervation of the oesophagus from the inflammatory disease process. Bleeding and dissemination are two other possible complications.