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What Causes Nausea And Pressure In Esophagus After Having Voriconazole?
Question: Hello,
I have been struggling with a culture proven overgrowth of Candida Parapisilosis in my mouth, throat, nasal passages( due to long term use (5 years) of broad spectrum antibiotics for acne )for about a year and have been treating this with topical Amphitericin B mostly successfully. 8 weeks ago I was prescribed Voriconazole (Vfend- 200 mg 2x day) to hopefully eradicate the Candida once and for all. 5 days into this drug I started feeling nausea and pressure in my esophagus area. I stayed on this drug for 14 days and finally had to stop due to these side effects. I fully expected this to subside but I am still having the same debilitating nausea and pressure in my esophagus and now some stomach pain 8 weeks later. I recently went to a GI Dr and had an endoscopy which was normal. No sign of stomach irritation, ulceration, or acid. Lab work and biopsies all normal. A quick stain for fungi was also negative. I am so miserable....only able to eat very bland food and small amounts of liquid and my symptoms never let up. I am 26 yrs old, very healthy and have never had any gastro issues in the past. I have been eating 100% organic for a year, eat no meat, dairy, eggs, or gluten, am preservative-free, and take probiotics daily. My GI doctor is baffled and has basically given up and told me to get another opinion elsewhere. I am hoping that you will be able to help me. Thanks!
I have been struggling with a culture proven overgrowth of Candida Parapisilosis in my mouth, throat, nasal passages( due to long term use (5 years) of broad spectrum antibiotics for acne )for about a year and have been treating this with topical Amphitericin B mostly successfully. 8 weeks ago I was prescribed Voriconazole (Vfend- 200 mg 2x day) to hopefully eradicate the Candida once and for all. 5 days into this drug I started feeling nausea and pressure in my esophagus area. I stayed on this drug for 14 days and finally had to stop due to these side effects. I fully expected this to subside but I am still having the same debilitating nausea and pressure in my esophagus and now some stomach pain 8 weeks later. I recently went to a GI Dr and had an endoscopy which was normal. No sign of stomach irritation, ulceration, or acid. Lab work and biopsies all normal. A quick stain for fungi was also negative. I am so miserable....only able to eat very bland food and small amounts of liquid and my symptoms never let up. I am 26 yrs old, very healthy and have never had any gastro issues in the past. I have been eating 100% organic for a year, eat no meat, dairy, eggs, or gluten, am preservative-free, and take probiotics daily. My GI doctor is baffled and has basically given up and told me to get another opinion elsewhere. I am hoping that you will be able to help me. Thanks!
Brief Answer:
As detailed below. Send pictures / give feedback.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate: 26 / Female - 5 years broad spectrum antibiotics for acne - 1 year Candida in mouth, throat, nose - topical Amphotericin -B topically ''mostly successful'' -Voriconazole for eradication - nausea and pressure in esophagus -
took only for 14 days - * nausea, pressure in esophagus, stomach pain continues 8 weeks - Gastroenterologist did Endo - normal - normal lab and biopsies - stain for fungi negative - can eat only bland diet - organic only, no to dairy, eggs, meat and gluten, preserrvative - Probiotic daily - Gastro asked for another opinion - tried all other therapies like aloe vera, but failed -
I would suggest you the following:
First of all send me different pictures of tongue, buccal mucosa, throat so that I too can asses.
Vit A and D in therapeutic dosage
Multivitamins
Avoid foods and beverages which you might have observed to increase the problems
Stress and anxiety control- This is the most important mother of all evils and has to be kept under control at any cost.
I hope your blood CBC, sugar, urea, creatinine, liver function tests, Thyroid function tests are within normal limits
- Gention violet was a wonder local application in olden day, please see if it is available in your area / Pharmacy.
_ I feel you should have normal, full diet of home-made-fresh food. Stopping many a things make one deplete of such minerals and elements that they are difficult to be supplemented. Once all food are started, you can keep a tract of the foods and the beverages which cause you the problems and then only to stop them.
- To continue the previous medicines like probiooptics and
(If the upper GI Is normal how can we explain the pain in the stomach, pressure in esophagus and nausea.)
I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more if you need to or if you feel that there is a gap of communication.
As detailed below. Send pictures / give feedback.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate: 26 / Female - 5 years broad spectrum antibiotics for acne - 1 year Candida in mouth, throat, nose - topical Amphotericin -B topically ''mostly successful'' -Voriconazole for eradication - nausea and pressure in esophagus -
took only for 14 days - * nausea, pressure in esophagus, stomach pain continues 8 weeks - Gastroenterologist did Endo - normal - normal lab and biopsies - stain for fungi negative - can eat only bland diet - organic only, no to dairy, eggs, meat and gluten, preserrvative - Probiotic daily - Gastro asked for another opinion - tried all other therapies like aloe vera, but failed -
I would suggest you the following:
First of all send me different pictures of tongue, buccal mucosa, throat so that I too can asses.
Vit A and D in therapeutic dosage
Multivitamins
Avoid foods and beverages which you might have observed to increase the problems
Stress and anxiety control- This is the most important mother of all evils and has to be kept under control at any cost.
I hope your blood CBC, sugar, urea, creatinine, liver function tests, Thyroid function tests are within normal limits
- Gention violet was a wonder local application in olden day, please see if it is available in your area / Pharmacy.
_ I feel you should have normal, full diet of home-made-fresh food. Stopping many a things make one deplete of such minerals and elements that they are difficult to be supplemented. Once all food are started, you can keep a tract of the foods and the beverages which cause you the problems and then only to stop them.
- To continue the previous medicines like probiooptics and
(If the upper GI Is normal how can we explain the pain in the stomach, pressure in esophagus and nausea.)
I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more if you need to or if you feel that there is a gap of communication.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your response and suggestions.
I do supplement with Vit D, B12, and multivitamin and have for years.
Food and Beverages do not affect my symptoms as I have been on a very bland diet since this started 8 weeks ago.
All of the bloodwork you mentioned has come back in normal range.
My diet prior to the onset of nausea after taking Voriconazole has been very healthy, including all home made foods-fruit, vegetables, grains, etc. I stopped eating meat, dairy, and gluton years ago and have been very healthy with no digestive problems or deficiencies until this happened. Again, no food or beverages affect my the constant nausea and pressure i have in my esophagus area and feeling that I have something stuck there. Also, no problem with swallowing.
I don't have pictures to share with you. My candida infection was diagnosed on culture not visual. It started with onset of burning tongue and metallic taste in my mouth. I had also had positive cultures for Candida Parapisilosis 2 years ago in my uriniary tract and vaginal tract which were treated successfully with Voriconazole (2 week of 200 mg 2x day- had no problems tolerating this then) and boric acid suppositories. I use these suppositories periodically when I feel symptomatic and they work well. My oral symptoms progressed to include burning and itching throat and itching in my ears. Treatment with topical Amphetericin B troches and nasal spray completely gets rid of the symptoms but unless I keep up with the treatment these symptoms return. This is the reason why I was prescribed Voriconazole.
The esophageal fungi stain from the biopsy came back negative, I spoke with the pathologist who said that a culture would have been more sensitive and possibly would detect candida, but the biopsy was already stained which would prevent culture growth so they are not able to do this. Each time I have been positive for candida it was diagnosed on a four week culture. I had explained this to my doctor and requested a culture, but somehow this information did not result in a request for the culture and now it is too late. I would have to undergo another endoscopy to obtain another sample for culture. Additionally, there was only 1 site biopsied for eosinophilic esophagitis which was negative. The pathologist said that there should have been more samples taken to determine this because of potential patchy distribution.
So my question now is could my symptoms be caused by a candida overgrowth in my esophagus area that somehow was set in motion by starting the Voriconazole and then symptoms are continuing because I was not able to complete the prescribed amount? And if this is the case, do I go back on the medication that caused my symptoms? Are there any other alternatives?
Please advise. Thank you.
I do supplement with Vit D, B12, and multivitamin and have for years.
Food and Beverages do not affect my symptoms as I have been on a very bland diet since this started 8 weeks ago.
All of the bloodwork you mentioned has come back in normal range.
My diet prior to the onset of nausea after taking Voriconazole has been very healthy, including all home made foods-fruit, vegetables, grains, etc. I stopped eating meat, dairy, and gluton years ago and have been very healthy with no digestive problems or deficiencies until this happened. Again, no food or beverages affect my the constant nausea and pressure i have in my esophagus area and feeling that I have something stuck there. Also, no problem with swallowing.
I don't have pictures to share with you. My candida infection was diagnosed on culture not visual. It started with onset of burning tongue and metallic taste in my mouth. I had also had positive cultures for Candida Parapisilosis 2 years ago in my uriniary tract and vaginal tract which were treated successfully with Voriconazole (2 week of 200 mg 2x day- had no problems tolerating this then) and boric acid suppositories. I use these suppositories periodically when I feel symptomatic and they work well. My oral symptoms progressed to include burning and itching throat and itching in my ears. Treatment with topical Amphetericin B troches and nasal spray completely gets rid of the symptoms but unless I keep up with the treatment these symptoms return. This is the reason why I was prescribed Voriconazole.
The esophageal fungi stain from the biopsy came back negative, I spoke with the pathologist who said that a culture would have been more sensitive and possibly would detect candida, but the biopsy was already stained which would prevent culture growth so they are not able to do this. Each time I have been positive for candida it was diagnosed on a four week culture. I had explained this to my doctor and requested a culture, but somehow this information did not result in a request for the culture and now it is too late. I would have to undergo another endoscopy to obtain another sample for culture. Additionally, there was only 1 site biopsied for eosinophilic esophagitis which was negative. The pathologist said that there should have been more samples taken to determine this because of potential patchy distribution.
So my question now is could my symptoms be caused by a candida overgrowth in my esophagus area that somehow was set in motion by starting the Voriconazole and then symptoms are continuing because I was not able to complete the prescribed amount? And if this is the case, do I go back on the medication that caused my symptoms? Are there any other alternatives?
Please advise. Thank you.
Brief Answer:
Try to get the diagnosis. ? stress/ ? Anxiety
Detailed Answer:
Thanks a lot for detailed summary of events, causes, medication, problems thereupon. Practically has to re-read and note down all your points differently (on paper).
Important points to recapitulate:
Your presenting symptoms are- Constant nausea, pressure in esophagus area and feeling that something is stuck there. (but no problem in swallowing).
Candida infection was diagnosed on culture not visual. It started with onset of burning tongue and metallic taste in my mouth. {also had positive cultures for Candida Parapisilosis 2 years ago in my uriniary tract and vaginal tract which were treated successfully with Voriconazole (2 week of 200 mg 2x day)- had no problems tolerating this then}
The esophageal fungi stain from the biopsy came back negative.
Endoscopy which was normal. No sign of stomach irritation, ulceration, or acid.
Never had any gastro issues in the past.
There was only 1 site biopsied for eosinophilic esophagitis which was negative.
GI doctor is baffled and has basically given up and told me to get another opinion elsewhere
*So my question now is:
could my symptoms be caused by a candida overgrowth in my esophagus area that somehow was set in motion by starting the Voriconazole and then symptoms are continuing because I was not able to complete the prescribed amount?
( H/O - 5 days into this drug I started feeling nausea and pressure in my esophagus area. I stayed on this drug for 14 days and finally had to stop due to these side effects.)
-You have completed 14 days of treatment
- The cause of the symptoms may be something else other than candida and should be sought after.
I would advise the following and request you to discuss with your treating Doctor:
*CT scan of the esophagus, chest. / MRI of the esophagus.
*Barium Swallow under Fluoroscopy control as this will show real-time motility of the esophagus.
Both these investigations may help to prove or rule out certain diseases / disorders related to your Symptoms.
And if this is the case, do I go back on the medication that caused my symptoms?
* Let the symptoms first be relieved
Are there any other alternatives?
* Depends upon the finding of the reports.
** Somehow I have a feeling that the stress and / anxiety can really enhance all such symptoms. Drink clean water to avoid gastrointestinal infections.
I hope this helps you, please feel free to discuss further, I shall be happy to assist you more.
Please give feedback.
Try to get the diagnosis. ? stress/ ? Anxiety
Detailed Answer:
Thanks a lot for detailed summary of events, causes, medication, problems thereupon. Practically has to re-read and note down all your points differently (on paper).
Important points to recapitulate:
Your presenting symptoms are- Constant nausea, pressure in esophagus area and feeling that something is stuck there. (but no problem in swallowing).
Candida infection was diagnosed on culture not visual. It started with onset of burning tongue and metallic taste in my mouth. {also had positive cultures for Candida Parapisilosis 2 years ago in my uriniary tract and vaginal tract which were treated successfully with Voriconazole (2 week of 200 mg 2x day)- had no problems tolerating this then}
The esophageal fungi stain from the biopsy came back negative.
Endoscopy which was normal. No sign of stomach irritation, ulceration, or acid.
Never had any gastro issues in the past.
There was only 1 site biopsied for eosinophilic esophagitis which was negative.
GI doctor is baffled and has basically given up and told me to get another opinion elsewhere
*So my question now is:
could my symptoms be caused by a candida overgrowth in my esophagus area that somehow was set in motion by starting the Voriconazole and then symptoms are continuing because I was not able to complete the prescribed amount?
( H/O - 5 days into this drug I started feeling nausea and pressure in my esophagus area. I stayed on this drug for 14 days and finally had to stop due to these side effects.)
-You have completed 14 days of treatment
- The cause of the symptoms may be something else other than candida and should be sought after.
I would advise the following and request you to discuss with your treating Doctor:
*CT scan of the esophagus, chest. / MRI of the esophagus.
*Barium Swallow under Fluoroscopy control as this will show real-time motility of the esophagus.
Both these investigations may help to prove or rule out certain diseases / disorders related to your Symptoms.
And if this is the case, do I go back on the medication that caused my symptoms?
* Let the symptoms first be relieved
Are there any other alternatives?
* Depends upon the finding of the reports.
** Somehow I have a feeling that the stress and / anxiety can really enhance all such symptoms. Drink clean water to avoid gastrointestinal infections.
I hope this helps you, please feel free to discuss further, I shall be happy to assist you more.
Please give feedback.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you so much for your very thorough answer and suggestions. I wish my GI doctor would be more investigative of my situation instead of giving up. I will attempt to approach him with your suggestions.
I have one more question.
What can I do to get relief from the extreme nausea that I am experiencing? I can hardly eat a bowl of rice noodles and sip on a small amount of liquid each day. This is such a far cry from the balanced and healthy diet that I have enjoyed my whole life. I am used to drinking 2-3 liters of bottled Icelandic Spring Water each day along with fresh green and fruit juice and smoothies. I have tried the following:
fresh ginger in spring water, organic cola, pepto bismol, baking soda, emetrol with no relief. I am desperate to get over this and get back to feeling healthy again.
Thank you.
I have one more question.
What can I do to get relief from the extreme nausea that I am experiencing? I can hardly eat a bowl of rice noodles and sip on a small amount of liquid each day. This is such a far cry from the balanced and healthy diet that I have enjoyed my whole life. I am used to drinking 2-3 liters of bottled Icelandic Spring Water each day along with fresh green and fruit juice and smoothies. I have tried the following:
fresh ginger in spring water, organic cola, pepto bismol, baking soda, emetrol with no relief. I am desperate to get over this and get back to feeling healthy again.
Thank you.
Brief Answer:
as detailed.
Detailed Answer:
Thanks for your feedback and appreciation.
Relief: of Extreme nausea.
Noted the solutions you have tried.
(Before the endoscopy when I assumed that this was irritation from the Vorconazole I did a 4 week regimen of DGL licorace, slippery elm, marshmellow root, and good quality aloe.) and (fresh ginger in spring water, organic cola, pepto bismol, baking soda, emetrol with no relief.)
I went through the details of the things you have tried and just as a thought, can one of these can be the reason for nausea, just a remote possibility.
Since the first list contains all herbal preparations, they have medicinal properties and so can have side effects also.
When none of that made a difference I began thinking that it might be an acid problem so I resorted to Zantac (Ranitidine) and Mallox (Antacid) which gave me no relief.
I want to emphasize again that I never had any gastro issues prior to this.
* So this also did not help.
My thoughts:
I would advise the following in such a patient:
Continue Zantac 12 hourly.
Antacid gel with anesthetic property like Happicid / Mucaine gel (please check with Pharmacy whether this is OTC or not, in your Country) every 3 to 4 hours when on empty stomach.
Add Domperidone or such motility regulators.
Soft bland diet.
No aerated colas / soda/ drinks.
Early dinner. No late nights.
Treatment for anxiety (as prescribed / needs a prescription by your Doctor)
Lying in a reclining position
Walk around after dinner.
Think of the factors which increased the present problem like anxiety and try to avoid.
This is just indicative and may help you. We want results.
Nausea is not a disease, it is foretelling that there is something that needs to be taken care of. Find the cause and you will be fine.
I have been trying my best to assist you, please feel free to give me the feedback, or ask any relevant queries, I shall be happy to assist you more till you get symptom-free.
as detailed.
Detailed Answer:
Thanks for your feedback and appreciation.
Relief: of Extreme nausea.
Noted the solutions you have tried.
(Before the endoscopy when I assumed that this was irritation from the Vorconazole I did a 4 week regimen of DGL licorace, slippery elm, marshmellow root, and good quality aloe.) and (fresh ginger in spring water, organic cola, pepto bismol, baking soda, emetrol with no relief.)
I went through the details of the things you have tried and just as a thought, can one of these can be the reason for nausea, just a remote possibility.
Since the first list contains all herbal preparations, they have medicinal properties and so can have side effects also.
When none of that made a difference I began thinking that it might be an acid problem so I resorted to Zantac (Ranitidine) and Mallox (Antacid) which gave me no relief.
I want to emphasize again that I never had any gastro issues prior to this.
* So this also did not help.
My thoughts:
I would advise the following in such a patient:
Continue Zantac 12 hourly.
Antacid gel with anesthetic property like Happicid / Mucaine gel (please check with Pharmacy whether this is OTC or not, in your Country) every 3 to 4 hours when on empty stomach.
Add Domperidone or such motility regulators.
Soft bland diet.
No aerated colas / soda/ drinks.
Early dinner. No late nights.
Treatment for anxiety (as prescribed / needs a prescription by your Doctor)
Lying in a reclining position
Walk around after dinner.
Think of the factors which increased the present problem like anxiety and try to avoid.
This is just indicative and may help you. We want results.
Nausea is not a disease, it is foretelling that there is something that needs to be taken care of. Find the cause and you will be fine.
I have been trying my best to assist you, please feel free to give me the feedback, or ask any relevant queries, I shall be happy to assist you more till you get symptom-free.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your thoughtful response.
You mentioned finding the cause for my nausea...
I am wondering since I have candida in my mouth and throat, could I have an overgrowth of candida in my esophagus and stomach that was exacerbated by taking Voriconazole? I have read on the internet that candida in these areas cause symptoms like mine. Have you experienced patients in this situation? and if so, what would your recommend?
Also you mentioned antacid therapy..Do you think this could be an acid problem even thought this wasn't seen during the endoscopy.
How would these medications work in my situation?
Thanks!
Thanks!
You mentioned finding the cause for my nausea...
I am wondering since I have candida in my mouth and throat, could I have an overgrowth of candida in my esophagus and stomach that was exacerbated by taking Voriconazole? I have read on the internet that candida in these areas cause symptoms like mine. Have you experienced patients in this situation? and if so, what would your recommend?
Also you mentioned antacid therapy..Do you think this could be an acid problem even thought this wasn't seen during the endoscopy.
How would these medications work in my situation?
Thanks!
Thanks!
Brief Answer:
get started the regime, let us have results also
Detailed Answer:
Hi.
Thanks for your feedback and further queries.
Very thoughtful indeed.
Upper GI would have shown some candida, the report said no.
So much candidias can occur only in immunocompromised person only and I am sure that you do not have any such problems. You have no such history.
You may please talk to your Doctor, discus and get the tests related to immunity, he has to order for that. If these tests CT / MRI of esophagus and throat are normal, everyone's anxiety will come down and helps in positive outcome.
As for the treatment I suggested, this is a standard protocol we follow and helps almost all the patients. We want results too. You have to get a relief is also the most important part.
I do have experienced such patients.
Candida is not shown in last endo, so stop thinking about it or get another one for culture you want. Negative result alone may help you to reduce the stress.
Please follow this new regimen I have suggested, try to get relief first.
Please give the feedback of positive results and help finding the cause.
get started the regime, let us have results also
Detailed Answer:
Hi.
Thanks for your feedback and further queries.
Very thoughtful indeed.
Upper GI would have shown some candida, the report said no.
So much candidias can occur only in immunocompromised person only and I am sure that you do not have any such problems. You have no such history.
You may please talk to your Doctor, discus and get the tests related to immunity, he has to order for that. If these tests CT / MRI of esophagus and throat are normal, everyone's anxiety will come down and helps in positive outcome.
As for the treatment I suggested, this is a standard protocol we follow and helps almost all the patients. We want results too. You have to get a relief is also the most important part.
I do have experienced such patients.
Candida is not shown in last endo, so stop thinking about it or get another one for culture you want. Negative result alone may help you to reduce the stress.
Please follow this new regimen I have suggested, try to get relief first.
Please give the feedback of positive results and help finding the cause.
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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