What is the role of esophageal barium study (esophagography) in the diagnosis of Candida esophagitis?

Updated: May 28, 2020
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Because Candida esophagitis is primarily a mucosal disease, it often is difficult to recognize with single-contrast esophagography. By contrast, double-contrast esophagography has a sensitivity of 90% in detecting the condition.

On double-contrast studies, Candida esophagitis initially is manifested by discrete plaquelike lesions in the esophagus. Usually, the plaques are oriented longitudinally, appearing en face as linear or irregular filling defects with normal intervening mucosa (see the image below). The plaques may be localized or diffuse and usually are located in the upper or middle esophagus. Some patients may have multiple tiny plaques, which produce a finely granular or nodular appearance of the mucosa.

Infectious esophagitis. Candida esophagitis. Doubl Infectious esophagitis. Candida esophagitis. Double-contrast esophagram shows linear plaquelike lesions in the esophagus, with normal intervening mucosa.

In advanced Candida esophagitis, the esophagus may have a grossly irregular or shaggy appearance as a result of innumerable plaques and pseudomembranes, with trapping of barium between the lesions (see the image below). This appearance is most commonly seen in patients with acquired immunodeficiency syndrome (AIDS); therefore, the presence of a shaggy esophagus should suggest the possibility of AIDS in patients who are not yet known to be positive for human immunodeficiency virus (HIV).

Infectious esophagitis. Two examples of advanced C Infectious esophagitis. Two examples of advanced Candida esophagitis demonstrate a shaggy esophagus. In both images, the double-contrast esophagram shows a grossly irregular esophageal contour due to innumerable plaques and pseudomembranes, with the trapping of barium between lesions. Patients with this fulminant form of esophageal candidiasis are almost always found to have acquired immunodeficiency syndrome (AIDS).

Some of the plaques and pseudomembranes may eventually be sloughed off, producing one or more areas of ulceration on a background of diffuse plaque formation. Occasionally, the barium may also dissect beneath the pseudomembranes, resulting in an intramural dissection tract or double-barrel esophagus.

In patients with chronic stasis, such as those with advanced achalasia or scleroderma involving the esophagus, superimposed Candida esophagitis may manifest as tiny nodules, polypoid folds, or a lacy appearance in the esophagus. Other patients with scleroderma or achalasia may have a foamy esophagus with innumerable bubbles layering out in the barium column as a result of a yeast form of the infection (see the image below). Other rare complications of esophageal candidiasis include perforation, tracheobronchial fistulas, and aortoesophageal fistulas.

Infectious esophagitis. Candida esophagitis with a Infectious esophagitis. Candida esophagitis with a foamy esophagus. This patient has a dilated esophagus with beaklike narrowing (arrow) at the gastroesophageal junction as a result of long-standing achalasia. Innumerable tiny bubbles are layering out in the barium column due to infection by the yeast form of candidiasis.

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