How is fungal esophagitis treated?

Updated: May 28, 2020
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Answer

Medical therapy for fungal conditions falls into the following three categories:

  • Topically active agents include nystatin, clotrimazole, and oral amphotericin B
  • Orally administered absorbable agents include fluconazole and itraconazole [55]
  • Parenterally administered agents include amphotericin B, fluconazole, and flucytosine

The choice of agent depends on the severity of infection and the degree of host defense impairment. Most patients with fungal esophagitis who are immunocompetent can be treated with a topical antifungal agent. They are virtually devoid of adverse effects and have few, if any, drug-drug interactions because these agents are not absorbed.

In a study at the digestive endoscopy unit of a Brazilian hospital, Wilheim et al found the incidence of esophageal candidiasis to be low, determining that 40 of 2,672 patients (1.5%) who underwent esophagogastroduodenoscopy (EGD) had endoscopic findings compatible with the disorder. [55] Just over half of these 40 patients were male, and 65% of them were inpatients. Of the 90% of patients in whom associated diseases were identified, 21 (52.5%) were infected with human immunodeficiency virus (HIV). Among the 21 patients younger than 50 years, 82.6% were HIV-positive.

In this study, endoscopy revealed severe forms of esophagitis in 50% of patients with a CD4 count below 200 cells/µL. Candida species other than Candida albicans were isolated in 22.7% and 45% of HIV-positive and HIV-negative patients, respectively. In six patients, the Candida samples were found to be fluconazole-resistant, whereas two samples had dose-dependent susceptibility to this agent.


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