Oesophageal Candidiasis

Key facts

• Oesophageal candidiasis is a Candida yeast infection of the food pipe, deeper and less visible than oral thrush.
• It mostly affects people with significantly weakened immunity, such as those living with HIV, undergoing chemotherapy, or taking high-dose corticosteroids.
• The hallmark symptom is painful or difficult swallowing, sometimes with a sensation that food is sticking, plus chest discomfort behind the breastbone.
• Treatment is a systemic antifungal: oral fluconazole is the usual first choice, with voriconazole reserved for cases that don't respond or involve a resistant strain.

Why the oesophagus, and who is at risk

Candida normally lives on the skin and mucosal surfaces without causing harm. When the immune system is significantly compromised, however, the yeast can overgrow and penetrate the lining of the oesophagus, which is why the infection is far more common in people living with HIV, undergoing chemotherapy, or taking high-dose corticosteroids than in the general population. The hallmark symptom is painful or difficult swallowing (odynophagia or dysphagia), sometimes with the sensation that food is sticking on the way down. Chest discomfort behind the breastbone is also common, and nausea or reduced appetite can follow if the infection is extensive. Diagnosis usually requires endoscopy to confirm the white plaques characteristic of the infection.

Antifungal treatment

Systemic antifungals are needed because topical treatments cannot reach the oesophagus reliably. Oral fluconazole is the usual first-line choice, taken for one to three weeks depending on severity. Voriconazole is used when first-line treatment has not worked or when the infecting strain is resistant. Seek prompt medical assessment if swallowing becomes very painful or you're unable to keep fluids down, since dehydration can develop quickly in that case.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.