Candida albicans: a cause or a consequence of esophageal intramural pseudo-diverticulosis

Abstract

Esophageal intramural pseudo-diverticulosis is a rare disease of unknown etiology. It is characterized by multiple pseudodiverticula with segmental or diffuse involvement of the esophagus. We report, the case of a 78-year-old male who suffered from severe dysphagia. Diagnosis of esophageal intramural pseudo-diverticulosis was based on endoscopic and radiologic explorations. Histological analysis of esophageal mucosal biopsies has shown the presence of candida albicans. Antifungal treatment leads to spectacular improvement of dysphasia. Subsequently, the patient presented a cardio-respiratory failure and died despite adequate treatment.

Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis

“…One infectious agent that has been discussed since the 1970s is candida, but no consensus on its causality in esophageal pseudodiverticulosis has been reached. 39,40 What can be deducted from case reports and small series is that the incidence and prevalence of candidiasis are comparatively high in DEIPD patients and that individuals who are negative for candida in one presentation can be positive in another. 7,13,41,42 On the other hand, asymptomatic candida colonization will also be found in a relevant portion of otherwise healthy individuals if only one looks close enough, and the variance between different populations is high.…”

“…15,26,27,47,48 Candida infections should always be searched for and, when found, treated according to existing guidelines or standards. 7,13,40,49,50 Since the diverticula probably cause a degree of stasis that may well predispose to chronic infection, it can be hypothesized that this infection causes fibrosis with scarring (see "Histology" above). Therefore, our own group recommends aggressive and prolonged local and systemic treatment of every candida occurrence.…”

“…In principle, these could be infectious, allergic, or autoimmune. One infectious agent that has been discussed since the 1970s is candida, but no consensus on its causality in esophageal pseudo‐diverticulosis has been reached 39,40 . What can be deducted from case reports and small series is that the incidence and prevalence of candidiasis are comparatively high in DEIPD patients and that individuals who are negative for candida in one presentation can be positive in another 7,13,41,42 .…”

“…Food impactions constitute an emergency and should be removed endoscopically 15,26,27,47,48 . Candida infections should always be searched for and, when found, treated according to existing guidelines or standards 7,13,40,49,50 . Since the diverticula probably cause a degree of stasis that may well predispose to chronic infection, it can be hypothesized that this infection causes fibrosis with scarring (see “Histology” above).…”

Clinical and endoscopic characteristics of diffuse esophageal intramural pseudo-diverticulosis

“…Endoscopic dilatation of strictures will give temporarily relief from dysphagia, and there are reports of beneficial effects of sucralfate [7,8]. Antifungal treatment can be helpful, though the significance of candidiasis is unclear [9,10]. Still, the disease typically takes a chronic course with frequent relapses, the reason for it being unknown.…”