Each of the following is a feature of Candida esophagitis EXCEPT:

A. barium esophagograms are frequently normal.
B. dysphagia is a common presenting symptom.
C. oral thrush is often not seen.
D. positive cultures of esophageal washings are diagnostic.
E. ulceration rarely extends beyond the mucosa. 

Answer D

Candida esophagitis occurs predominantly in immunocompromised patients, often in the absence of an oral thrush or an abnormal esophagogram. The endoscopic appearance is diagnostic with small amounts of whitish exudate over an erythematous or occasionally normal mucosa. With progression, the amount of exudate as well as the intensity of the mucosal inflammation increases. The ulcerative process affects the mucosa and rarely extends through the esophageal wall. Unrecognized disease can progress to stricture formation. Differential diagnosis includes herpetic and peptic esophagitis. Examination of a brush or biopsy specimen reveals mycelia and/or yeast forms. Cultures are usually not reliable since Candida is normally present in the gastrointestinal tract.