|
|
|
|
|
|
|
| Fungal Esophagitis | ||
| Etiology •Multiple etiologies exist for irritation of the esophageal mucosa causing microscopic and clinical esophagitis •The most frequent are: peptic irritation (gastroesophageal reflux disease (GERD) or nonGERD); infectious (viral, fungal or bacterial); toxic (chemical); cytotoxic chemotherapy; irritants(alcohol, smoking, hot fluids and foodstuffs) | ||
| Pathogenesis •In the U.S. peptic irritation is the major cause and this involves exposure of epithelium to the caustic effect of acid •An increasingly common occurrence is fungal or less commonly viral superinfection in an immunocomp[romised host either due to primary immunodeficiancy or secondary to chemotherapy, | ||
| Epidemiology •Great variation in incidence exists geographically ranging from estimates of 5-10% in the U.S. to 80% in Iran •In the U.S. the primary cause is gastroesophageal reflux (GERD) while in France it is alcohol consumption and in Iran and the far east dietary | ||
| General Gross Description •The gross appearance will vary dependant on the etiology •The common finding is evidence of inflammation with reddening, exudate, debris, possible slight edema and in severe cases erosion or ulceration •In fungal esophagitis, most commonly Candida, multiple white patches are seen similar to oral thrush •In Herpes or CMV punched out ulcers are seen •Radiation will show evidence of epithelial atrophy with thinning rather than signs of inflammation and in late cases narrowing leading to stricture •Examples: | ||
| General Microscopic Description •Depending on severity the microscopic findings show acute inflammation, necrosis and ulceration. •Areas of extensive necrosis can be found and fungi are more easily demonstrated with PAS and silver stains. •Examples: | ||
| Clinical Correlation •Candida esophagitis may require intravenous antibiotics and the response is variable depending on the severity o the underlying disease. | ||
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp.762. Please be patient during transfer. Medline will open in a new window. To return, close the Medline Window Fungal Esophagitis
| Synopsis by: Martin Nadel M.D. (T62000M40030)[379]
| |
|
|
|
|
|
|