{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:56:12Z","timestamp":1790873772524,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Candida esophagitis (CE) is the most common fungal infection of the esophagus and an increasingly recognized complication in patients with solid organ malignancies. Once primarily associated with advanced HIV\/AIDS and hematologic malignancies, the epidemiology has shifted in the modern era of antiretroviral therapy and intensive cancer treatments. Patients with solid tumors receiving chemotherapy, corticosteroids, broad-spectrum antibiotics, and proton pump inhibitors (PPIs) are at a heightened risk for CE due to synergistic immunosuppressive and mucosal barrier-disrupting effects. Clinically, CE in cancer patients often present with odynophagia, dysphagia, or chest pain, but a considerable proportion of cases are asymptomatic or non-specific, complicating diagnosis and needing a high index of suspicion. Endoscopic evaluation with characteristic white plaques and histopathologic confirmation remains the diagnostic gold standard, as symptoms as oropharyngeal findings are unreliable indicators of esophageal infection. Disease management centers on systemic antifungal therapy. Fluconazole is the first-line treatment, achieving high cure rates, while echinocandins and posaconazole are reserved for refractory cases or non-albicans infections. Prompt therapy is crucial, as untreated CE can lead to malnutrition, interruptions in cancer therapy, and rare but serious complications (e.g., necrotizing esophagitis or perforation). We provide a comprehensive review of the epidemiology, risk factors, clinical manifestations, pathogenesis, diagnosis, and management of CE in solid organ cancer patients. Gaps in knowledge are highlighted, including the need for better non-invasive diagnostics, antifungal resistance surveillance, and tailored prophylactic strategies. A high index of suspicion and early recognition and treatment of CE in oncology patients can improve nutritional status, quality of life, and continuity of cancer care.<\/jats:p>","DOI":"10.3390\/jcm15041474","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:52:21Z","timestamp":1770979941000},"page":"1474","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Candida Esophagitis in Patients with Solid Organ Cancers"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8391-426X","authenticated-orcid":false,"given":"Ahmed","family":"Telbany","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, University of New Mexico, Albuquerque, NM 87106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Farfour","sequence":"additional","affiliation":[{"name":"Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, City of Hope Phoenix, Goodyear, AZ 85338, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6865-8536","authenticated-orcid":false,"given":"Youssef","family":"Soliman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, City of Hope Phoenix, Goodyear, AZ 85338, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toufic A.","family":"Kachaamy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, City of Hope Phoenix, Goodyear, AZ 85338, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"106172","DOI":"10.1016\/j.jinf.2024.106172","article-title":"The modern face of esophageal candidiasis in an oncology center: Correlating clinical manifestations, endoscopic grade, and pathological data in 323 contemporary cancer patients","volume":"89","author":"Matsuo","year":"2024","journal-title":"J. Infect."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S209","DOI":"10.4103\/jcrt.JCRT_581_18","article-title":"Fungal profile and antifungal susceptibility pattern of candidiasis in esophageal cancer patients","volume":"16","author":"Talukdar","year":"2020","journal-title":"J. Cancer Res. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3585136","DOI":"10.1155\/2019\/3585136","article-title":"Diagnosis and treatment of esophageal candidiasis: Current updates","volume":"2019","author":"Mohamed","year":"2019","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"480","DOI":"10.4253\/wjge.v15.i6.480","article-title":"Prevalence and clinical risk factors for esophageal candidiasis in non-human immunodeficiency virus patients: A multicenter retrospective case-control study","volume":"15","author":"Kimchy","year":"2023","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10896","DOI":"10.12998\/wjcc.v10.i30.10896","article-title":"Prevalence and risk factors for Candida esophagitis among human immunodeficiency virus-negative individuals","volume":"10","author":"Chen","year":"2022","journal-title":"World J. Clin. Cases"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s100960050437","article-title":"Risk factors for esophageal candidiasis","volume":"19","year":"2000","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Dong, Y., Tao, H., Liu, L., Ni, Z., Yang, Z., Chen, K., He, S., Peng, L., and Chen, X. (2023). The association between Geriatric Nutritional Risk Index and the risk of Invasive Candidiasis in critically ill older adults. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08512-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"30724","DOI":"10.1038\/s41598-025-16066-6","article-title":"Risk factors for invasive fungal infections in adult patients with hematological malignancies and\/or stem cell transplant: A systematic review and meta-analysis","volume":"15","author":"Gras","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1111\/his.14063","article-title":"The diagnosis of clinically significant esophageal Candida infections: A reappraisal of clinicopathological findings","volume":"76","author":"Hissong","year":"2020","journal-title":"Histopathology"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Takahashi, Y., Nagata, N., Shimbo, T., Nishijima, T., Watanabe, K., Aoki, T., Sekine, K., Okubo, H., Watanabe, K., and Sakurai, T. (2015). Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0133589"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kim, D.Y., Oh, K., Song, M., Kweon, H., Nho, D., Hong, H., Lee, R., Lee, D.G., and Cho, S.Y. (2025). Epidemiology and Characteristics of Invasive Yeast Infections in Patients with Hematologic Diseases: 12-Year Single-Center Retrospective Cohort Study. J. Fungi, 11.","DOI":"10.3390\/jof11080585"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"bcr2015210477","DOI":"10.1136\/bcr-2015-210477","article-title":"Necrotising Candida oesophagitis after thoracic radiotherapy: Significance of oesophageal wall oedema on CT","volume":"2015","author":"Saito","year":"2015","journal-title":"BMJ Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"20663","DOI":"10.1038\/s41598-021-00132-w","article-title":"Risk factors for the development of esophageal candidiasis among patients in community hospital","volume":"11","author":"Ogiso","year":"2021","journal-title":"Sci Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1086\/514653","article-title":"Oropharyngeal candidiasis as a marker for esophageal candidiasis in patients with cancer","volume":"27","author":"Samonis","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","first-page":"333","article-title":"Etiology, diagnosis and treatment of infectious esophagitis","volume":"8","author":"Kierzkiewicz","year":"2013","journal-title":"Prz. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/1752-1947-2-209","article-title":"Candida esophageal perforation and esophagopleural fistula: A case report","volume":"2","author":"Quintero","year":"2008","journal-title":"J. Med. Case Rep."},{"key":"ref_18","first-page":"189","article-title":"Candida albicans the main opportunistic pathogenic fungus in humans","volume":"55","year":"2023","journal-title":"Rev. Argent. Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1590\/S0036-46652008000500002","article-title":"Candida esophagitis: Species distribution and risk factors for infection","volume":"50","author":"Kliemann","year":"2008","journal-title":"Rev. Inst. Med. Trop. S\u00e3o Paulo"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"371631","DOI":"10.1155\/2014\/371631","article-title":"Candida glabrata Esophagitis: Are We Seeing the Emergence of a New Azole-Resistant Pathogen?","volume":"2014","author":"Wilson","year":"2014","journal-title":"Int. J. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lauwers, G.Y., Mino-Kenudson, M., and Kradin, R.L. (2010). Inections of the GI tract. Diagnostic Pathology of Infectious Diseases, Saunders.","DOI":"10.1016\/B978-1-4160-3429-2.00009-2"},{"key":"ref_22","first-page":"211","article-title":"Candidiasis esof\u00e1gica: An\u00e1lisis cl\u00ednico y micol\u00f3gico [Oesophageal candidiasis: Clinical and mycological analysis]","volume":"35","author":"Olmos","year":"2005","journal-title":"Acta Gastroenterol. Latinoam."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Eades, C.P., Bakri, A.R.B.A., Lau, J.C.Y., Moore, C.B., Novak-Frazer, L., Richardson, M.D., and Rautemaa-Richardson, R. (2023). Comparison of \u03b2-1-3-D-Glucan and Candida Mannan Biomarker Assays with Serological Tests for the Diagnosis of Candidemia. J. Fungi, 9.","DOI":"10.3390\/jof9080813"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Felix, G.N., de Freitas, V.L.T., da Silva Junior, A.R., Magri, M.M.C., Rossi, F., Sejas, O.N.E., Abdala, E., Malbouisson, L.M.S., Guimar\u00e3es, T., and Benard, G. (2023). Performance of a Real-Time PCR Assay for the Detection of Five Candida Species in Blood Samples from ICU Patients at Risk of Candidemia. J. Fungi, 9.","DOI":"10.3390\/jof9060635"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hirai, T., and Nashi, M. (2025). Pharmacological Management of Oral and Esophageal Candidiasis: A Clinical Pharmacotherapy Perspective. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217537"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"236","DOI":"10.37201\/req\/013.2023","article-title":"Recommendations on the use of azole antifungals in hematology-oncology patients","volume":"36","author":"Azanza","year":"2023","journal-title":"Rev. Esp. Quimioter."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1055\/s-0035-1562902","article-title":"Posaconazole: Use in the Prophylaxis and Treatment of Fungal Infections","volume":"36","author":"Clark","year":"2015","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"106590","DOI":"10.1016\/j.ijantimicag.2022.106590","article-title":"Systemic antifungal therapy for oesophageal candidiasis\u2014Systematic review and meta-analysis of randomized controlled trials","volume":"59","author":"Mwassi","year":"2022","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"myaf097","DOI":"10.1093\/mmy\/myaf097","article-title":"Deep learning for the identification of Candida spp. directly from blood culture gram stains from candidemia patients","volume":"63","year":"2025","journal-title":"Med. Mycol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1007\/s00066-009-1938-3","article-title":"Amphotericin B lozengers: Prophylaxis for esophagitis in thoracic radiotherapy: A prospective study","volume":"185","author":"Wurstbauer","year":"2009","journal-title":"Strahlenther. Onkol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s40588-020-00154-4","article-title":"Fungal Infections Associated with the Use of Novel Immunotherapeutic Agents","volume":"7","author":"Bernardes","year":"2020","journal-title":"Curr. Clin. Microbiol. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1474\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T11:20:56Z","timestamp":1770981656000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041474"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041474","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}