Pathophysiologic basis of the foamy esophagus is uncertain. Stasis is a predisposing factor. Foam is produced directly by the fungal organisms that colonize in the esophagus due to production of carbon dioxide via oxidative respiration.
The foamy esophagus is characterized by multiple tiny (1-3 mm), round lucencies that are mixed with the barium suspension along the top of the barium column, producing a layer of foam.
Other fluoroscopic signs of Candida oesophagitis include:
- multiple plaques
- discrete ulcers (mimicking herpes)
- cobblestone/snake skin appearence: when plaques are coalescent
- shaggy esophagus: when plaques and pseudo-membranes coalesce
- intramural pseudodiverticulosis
- double barrel oesophagus
- benign stricture is also seen in late stage of disease
- 1. Sam JW, Levine MS, Rubesin SE et-al. The "foamy" esophagus: a radiographic sign of Candida esophagitis. AJR Am J Roentgenol. 2000;174 (4): 999-1002. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Levine MS, Rubesin SE, Herlinger H et-al. Double-contrast upper gastrointestinal examination: technique and interpretation. Radiology. 1988;168 (3): 593-602. Radiology (citation) - Pubmed citation