Candidal infection is uncommon in acute oesophagitis: evidence from a non-selected DGH population.

Mucosal candida infection of the lower oesophagus is unusual except in certain groups of patients who are either immuno-suppressed or who have other recognised causes of candidal infection. 1 Invasive oesophageal candidiasis occurs most often in the immunosuppressed, occurring in 10– 20% of patients with myeloproliferative disorders or leukaemia and in up to 74% of patients with AIDS, with an increased frequency of infection in patients with endo-crine disorders such as hypoparathyroidism. 1 Previous studies have shown that the incidence of candidal infection in 22 000 consecutive hospital admissions was 0.1% (27 cases), whereas it was found in less than 5% of a general population presenting with gastrointestinal complaints. 2 It is important to exclude invasive candidiasis as this is a major risk factor in the development of candidal septicaemia, which can result as a direct eVect of visceral wall invasion. Complications of oesophageal candidiasis also include oesophageal stenosis and perforation, which may occur in the acute phase of infection , and which can be life threatening. Less commonly, pseudodiverticulosis may also result. 1 Candidal oesophagitis is caused most commonly by C albicans, C tropicalis, and C krusei. 3 The diagnosis of invasive candidiasis requires a combination of clinical suspicion and laboratory investigation. DiYculties in diagnosis arise where the clinical presentation is non-specific or serology produces false positive results because of vulvovaginal can-didiasis. Oesophageal brushings are useful for identifying mucosal surface candidal coloni-sation but are poor at detecting fungal invasion. 4 5 Here we present the results of a retrospective review of 60 cases of acute oesophagitis, with reassessment for candida by D-PAS staining. Sixty consecutive oesophageal biopsies coded on the laboratory computer SNOMED database as acute inflammation with or without ulceration were examined from the period 1997–1998. In our hospital few specimens are sent for mycological culture, and brush cytology is not performed for the diagnosis of candida. Candidal staining—All cases had remaining tissue available. Additional sections were cut if no spare unstained sections were available and then the sections were stained with PAS-D. Sections were pretreated with fresh diastase solution (0.5 cm 3 diastase in 50 ml deionised water) followed by treatment with periodic acid SchiV reagent and Carrazzi's haematoxylin, with tapwater washes in between each stage. The original H&E sections were reexamined to identify the presence of squamous mucosa or gastric mucosa and the nature of inflammation present (acute or chronic). The sections were also reexamined for …