Increasing Incidence
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I am a pediatric GI. I have notice an increasing amount of fungal esophagitis in my patients. Sometimes this is preceded by steroid and antibiotic exposure but other times not. Sorry for long list of questions but 1. Why the increasing incidence? 2. Can I assume they have invasive candida if they have yeast esophagus or do I still need to do the OAT or mOAT? 3. I am traditionally trained to just do a 3 week course of diflucan but after listening to your lectures it seems that I need to treat this much longer. Just want to verify that is the case. Can I transition to botanicals after the 3 week course of nystation. I feel like I am making up protocols as I go…thanks
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Dr. Carey,
Great questions. Much of this will make more sense as we get through the next few modules, particularly with regards to the need for the OAT/mOAT.1 – I believe there are many reasons such as increasing chemicals in our environment, including our foods, which is weakening the immune system. When you say increasing incidence, what is the time frame for this? 1 year, 2 years? Many, many years?
2 – I would still advocate for the OAT or mOAT because of the clostridia possibility (which we will be discussing in Module #5), oxalates, and other metabolic imbalances. However, with what you are seeing I would say there is definitely invasive candida. It would be very interesting to correlate some laboratory testing to your visualization examinations.
3 – I would advocate for longer treatments, but that doesn’t mean you need to use Diflucan as an ongoing therapy. This is whey the OAT or mOAT is so important so you have a reference point to re-evaluate for, as well as the clinical response of the patient. Diflucan can do a lot to get the levels of yeast down, and then rotating with Nystatin, as well as various botanicals can work too. You absolutely can transition to botanicals after a short-course of Diflucan. The same can be true of Nystatin where it can be used for much longer periods of time (many, many months) and even rotated or used concurrently with botanicals.
I hope this helps.
Sincerely,
Dr. Woeller-
Dr Woeller
Thanks for the information
I have been doing this about 10 years and I would say the increased incidence of visible yeast esophagitis on endoscopy has really been over the last 2 years. I have had patients whose only risk factor seems diet (no steroids, antibiotics etc). I probably was missing it before as I had never heard of OAT testing until about a year ago and like you have said culturing yeast is hard to do.
Rebecca
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Rebecca,
The yeast has probably been there, but overlooked. I think this is fairly common. I haven’t personally seen a large increase of invasive candida problems in just the past few years, but for longer period of time so it is likely been an unforeseen issue for many, many years.Sincerely,
Dr. Woeller
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