Symptoms of esophageal candidiasis from inhaled steroids

[Polzovatel]

Has anybody had Esophageal candidiasis from inhaled steroids and what were your symptoms?

[Hidden]

I’ve had oesophageal candidiasis - twice, both found via gastroscopy: the first time very, very mildly, the second time rather more serious, but there was some dispute as to what caused it. The consultant gastroenterologist who found it the second time was convinced it was due to my steroid inhaler (I’m on fluticasone - Flixotide 250 - via an accuhaler) and inadequate rinsing/gargling after using it, but given that I’ve never had oral or pharyngeal thrush in my life he was the only doctor who thought that. Neither my GP nor a respiratory consultant agreed with him.

Symptoms: in my case appalling heartburn usually commencing about half an hour to forty-five minutes after a meal had finished and persisting for a further half an hour to forty five minutes. I used to curl up in a chair and just wait in abject misery for it to calm down.

So if it wasn’t the inhalers, what might have caused it? Well, in my case I was already losing weight due to pre existing digestive issues before the symptoms became really obvious. After the second time I got recurring episodes about three times in the following eighteen months or so - despite the fact that I’d upped my rinsing out technique further and the respiratory consultant was more than happy with what I was doing. Personally, I rather suspect that the fact that I was clinically underweight due to those digestive issues might have had something to do with it - the immune system can be compromised in such situations. After my weight got above a certain level I had no more episodes - nor have I had it since, but my weight has been fine. It was also notable that on both occasions I got it after I had been using flixonase (steroid nasal spray), and I know some of that had got to the back of my throat and so presumably down my oesophagus - it has rather a distinctive taste. Now I’d been using flixonase on and off for years with no problem, so if the nasal spray did have something to do with it (and I emphasise the ‘if’), it was part of a more complex problem. That said, I’m now on a different nasal spray.

It is quite a rare condition; the GP I saw admitted that in thirty plus years of being in practice he’d only come across one other case of it - and the other individual was a smoker (which I am not and never have been).

Do I take it from your question that you have got this condition? If so, you have my sympathy - it is most unpleasant!

[Polzovatel in reply to Hidden]

Hi Maggie,

Thank you very much for your detailed response. I had gastroscopy yesterday and was diagnosed with esophageal candidiasis. I am also on flixotide (250 x 4 a day) and flixonase nasules (400 x 2 a day) for sinusitis. Which nasal spray are you using now? I've been on nasules for a while as spray dosage was not sufficient - I was having sinus headaches, every day for months - wonder if flixonase nasules caused the esophageal thrush.

I have abdominal pains and bad nausea which started a couple of months ago,so my main question is if bad nausea could be caused by esophageal candidiasis.

My gastro is not sure so he suggested to double omeprasole and ranitidine for a couple of weeks and if this doesn't help, I will be referred for an abdominal CT.

Did you take any antifungal medicine for this (fluconazole) , how long did your last episode last for?

[Hidden in reply to Polzovatel]

We’re on the same steroid inhaler then, though I only use the 2x2 dose in the winter months. In the summer I can reduce it to 2x1, with roughly spring and autumn at a dosage of 2 in the evening and 1 in the morning. I assume you do have a thorough rinsing regime: I usually gargle, clean my teeth thoroughly and then gargle again after using my steroid inhaler.

I was also put on fluconazole for the oesophageal thrush: one 50mg tablet a day for two weeks. I can report that it certainly seemed to clear it up.

I don’t recall bad nausea being a problem - the main issue was the heartburn, which really was horrendous! Abdominal pain, yes, but in one particular area - right at the top of the stomach in the v between the lower part of the rib cage, so just below the sternum (not surprising really - when the thrush was found it was deep down in the oesophagus and had resulted in oesophagitis). However, having checked symptoms of oesophageal thrush online, nausea is listed - though top of the list is definitely heartburn.

I’m now on Rinatec (Ipratropium bromide) nasal spray, but I only use this on an as and when needed basis (which was also true of the Flixonase). My sinuses do flare up, but I have never used my nasal sprays for it; I depend more on olbas oil and (when it was available - sadly it no longer is) Karvol capsules to help with that. The problem I have with nasal sprays is that they do tend to irritate my nasal passages, resulting in nosebleeds (usually minor, though they can get worse) if I take them on a daily basis for too long.

Having checked side effects of Flonase (which I think is another name for flixonase) I notice that nausea is listed as an infrequent side effect and fungal infections of the throat a rare side effect. It might be worth discussing both with your GP, particularly if the fluconazole doesn’t help with the nausea.

[Polzovatel in reply to Hidden]

Thanks for your reply. How long did it take until Fluconazole started taking effect?

[Hidden in reply to Polzovatel]

I have a feeling it was several days before it really started kicking in.

[Jjude1003]

After endoscopy dr reported ‘minor’ signs of it and prescribed anribiotic. He said that would take care of it and didnt seem too concerned. I made sure to be more diligent about rinsing after using my inhalers ever since. I rinse and spit several times and then drink down a glass of water.