Clinical findings and risk factors for Candida esophagitis in outpatients

We retrospectively reviewed 18 patients with endoscopically discovered Candida esophagitis to more fully characterize this entity and identify predisposing conditions. Candida esophagitis was defined by the presence of fungal mycelia on brush cytology. Only two patients had an associated malignancy. Other possible predisposing risk factors were acid suppressive therapy (14 patients), prior gastric surgery (five), mucosal barrier injury (four), inhaled steroid use (four), oral steroid use (three), esophageal motility disorders (three), rheumatologic disorders (three), prior antibiotic use (two) and diabetes mellitus (two). The majority of patients had more than one proposed risk factor. Ten (56%) were treated with antifungal therapy. Thus, Candida esophagitis was infrequently seen in patients with associated malignancy. Prospective evaluation of predisposing conditions and treatment is recommended.