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Introduction Oesophageal candidiasis is commonly encountered during upper gastrointestinal endoscopy, but its endoscopic appearance can overlap with other conditions, raising concerns about diagnostic accuracy and appropriate management. This study assessed how often suspected oesophageal candidiasis is correctly identified, confirmed histologically, and appropriately treated in routine clinical practice.Methods A retrospective review was performed of approximately 800 esophagogastroduodenoscopies conducted at a single centre in 2022. Forty-eight cases with endoscopic features suggestive of oesophageal candidiasis were identified through image review. Data collected included patient demographics, symptoms, endoscopic diagnosis, Kodsi grade, biopsy rates, histological outcomes, antifungal treatment, and investigation of predisposing factors. Statistical analysis was performed using Prism software, including Pearson’s chi-square test to assess agreement between endoscopic and histological diagnoses.Results Of the 48 suspected cases, only 18 (37.5%) were diagnosed endoscopically as oesophageal candidiasis. Biopsies were taken in fewer than 30% of cases overall and in 32% of symptomatic patients. When biopsies were taken following an endoscopic diagnosis, histology confirmed candidiasis in 83.3% of cases (p=0.003). Mild disease (Kodsi grades 1–2) was most common. Of the 18 endoscopically diagnosed cases, only 11 (61%) received antifungal treatment, including cases with histologically confirmed disease that were untreated. All treated patients received fluconazole, irrespective of disease severity. Investigation of potential predisposing factors was documented in only 16.6% (3/18) of diagnosed cases.Conclusion Oesophageal candidiasis is inconsistently investigated and managed in routine endoscopic practice. While endoscopic diagnosis is frequently accurate when biopsies are obtained, low biopsy rates, incomplete treatment, and limited evaluation of underlying risk factors represent significant gaps in care. Greater emphasis on histological confirmation, appropriate antifungal treatment, and assessment of predisposing factors may improve patient management.