CANDIDA ESOPHAGITIS IN INFANTS WITH GASTROESOPHAGEAL REFLUX AND FEEDING INTOLERANCE

Abstract

Purpose: The aim of this study was to examine the role of Candida esophagitis in infants with symptoms of gastroesophageal reflux disease (GERD) and significant feeding intolerance. Methods: A clinical database was queried to identify all children diagnosed with both Candida esophagitis and GERD since 1999. 10 patients were identified, and data were collected regarding their dietary history, medications, growth, and response to prior therapies. All of these patients underwent esophagogastroduodenoscopy (EGD) with biopsies and/or esophageal brushings. Results: There were 10 infants, age 1 wk-7 mo (0.32 yr ± 0.26), 70% male, 50% African American, 40% Caucasian, 10% Hispanic. All of the patients had vomiting, 80% had feeding intolerance, 60% had diarrhea, 50% had allergic colitis, and 30% had oral candidiasis. None had any history or clinical evidence of immunosupression. All patients were below the mean for weight forage (z-score,-1.72 ±1.14, mean ± SD, range-3.51 to-0.04). Only one of the infants had received recent antibiotic therapy. There had been no improvement in the patients' symptoms, weight, or feeding tolerance despite multiple formula changes, and appropriate empiric therapy with ranitidine, metoclopramide, or various proton pump inhibitors. After Candida esophagitis was diagnosed at EGD (biopsy and/or brushings), all patients were treated with fluconazole 5 mg/kg/d. All 10 patients demonstrated improvement in their symptoms following treatment. Follow-up data were obtained in 8 patients (range 1–8 months, mean 5.7 months). Among the patients for whom follow-up data are available, there was a significant improvement in the patients' weight-for-age z-scores following treatment (-1.97 ± 1.10, range-3.51 to-0.78 versus- 0.32 ± 0.70, range-1.44 to 0.44, p = 0.005, pre-treatment vs. final follow-up visit respectively). Conclusions:Candida esophagitis should be included in the differential diagnosis of immunocompetent infants presenting with symptoms of GERD and feeding intolerance not responsive to appropriate therapy. EGD should be considered in the diagnostic evaluation of such patients. The absence of oral candidiasis does not exclude the possibility of Candida esophagitis.