Diagnosis

Endoscopic diagnostic criteria

Location

- All portions of the esophagus may be affected

- Often located on the crest of the mucosal folds

Morphology

Early

- Scattered punctate plaques, which

(Fig. 3.36 a, b)

may be whitish, yellowish, or

cream-colored

- A few millimeters in size, slightly

raised

- Mucosa under the plaques may be

normal, erythematous, or friable

- Surrounding mucosa normal

Later

- Streaky, confluent plaques and

(Fig. 3.36 c-e)

pseudomembranes

- Tenacious, difficult to dislodge

- Mucosa under the plaques is

edematous, friable, bleeds easily

- Mucosal erythema, erosion, ulcera-

tion, necrosis

Late

- Changes affect the entire cir-

(Fig. 3.36 f)

cumference

- Luminal narrowing

- Necrosis

- Bleeding

Differential diagnosis

The whitish plaques are fairly typical.

Herpes simplex (HSV) esophagitis

Cytomegalovirus (CMV) esophagitis

Checklist for endoscopic evaluation

Morphology of the individual lesions

Location and extent

Signs of bleeding, ulceration

Fig. 3.36 Candida esophagitis a Early stage

b Moderate involvement

Fig. 3.36 Candida esophagitis a Early stage b Moderate involvement

e Pronounced involvement f Advanced form with thick exudate e Pronounced involvement f Advanced form with thick exudate

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