Читать книгу The Esophagus - Группа авторов - Страница 171

Candida albicans is the most common cause of infectious esophagitis. It usually occurs as an opportunistic infection in immunocompromised patients, but Candida esophagitis may also result from local esophageal stasis caused by severe esophageal motility disorders such as achalasia and scleroderma [86]. In some patients with these motility disorders, a “foamy” esophagus may develop with innumerable tiny bubbles layering out in the barium column; this phenomenon presumably results from esophageal infection by the yeast form of the organism [87]. Single‐contrast barium studies have limited value in detecting Candida esophagitis because of the superficial nature of the disease. In contrast, double‐contrast barium studies have a sensitivity of about 90% in diagnosing Candida esophagitis in relation to endoscopy [88, 89], primarily because of the ability to demonstrate mucosal plaques with this technique.

Candida esophagitis is usually manifested on double‐contrast studies by discrete plaque‐like lesions corresponding to the white plaques seen on endoscopy [88]. The plaques may appear as linear or irregular filling defects that are often oriented longitudinally in relation to the long axis of the esophagus and are separated by segments of normal intervening mucosa [88] (Figure 6.45). A much more fulminant form of candidiasis has been encountered in patients with AIDS, who may present with a grossly irregular or “shaggy” esophagus caused by innumerable coalescent plaques and pseudomembranes with trapping of barium between the lesions [90] (Figure 6.46). Some of these plaques may eventually slough, producing one or more deep ulcers superimposed on a background of diffuse plaque formation (Figure 6.46). However, this type of advanced Candida esophagitis is rarely encountered in modern medical practice because of better antiviral therapy of HIV‐positive patients and the infrequent development of AIDS. Patients with typical findings of Candida esophagitis on double‐contrast studies can be treated with antifungal agents such as fluconazole without need for endoscopy.

Figure 6.35 Normal esophagus and cardia. (A) Double‐contrast view of the esophagus shows how it normally has a smooth, featureless appearance en face. (B) Mucosal relief view shows thin, straight longitudinal folds as a normal finding in the collapsed esophagus. (C) Recumbent right lateral view of the gastric fundus shows stellate folds radiating to a central point (arrow) at the gastroesophageal junction, also known as the cardiac “rosette.”