LNSLNS I was rather surprised that yeasts in the gut are the subject of serious discussion in the medical literature.

As Professor Ottenjann (text book author, joint founding father of flexible endoscopy in Germany), with whom I exchanged letters and had discussions regarding possible intestinal yeast infections in the early 1980s, explained to me at the time: “Yeasts require squamous epithelium; this ends at the Z line and re-surfaces at the dentate line. Only in that location are you likely to find yeasts on the mucosa, with corresponding inflammatory reactions.”

Since I was doubtful he asked me to send him an image and a case report if I ever came upon such a finding on endoscopy of the stomach or gut.

In spite of undertaking more than 25 000 endoscopies, with 3–5 times the number of associated biopsies, I have remained unsuccessful. The only scenario where I found yeast colonization distal to the esophagus was in necrotically disintegrating tumors of the stomach and intestine (cylinder epithelium)—and in these cases, the yeast was the least of the patients’ problems.

Only for completeness’s sake, I wish to mention that orally ingested fungal spores are not digested, and any laboratory should be able to grow yeasts from a stool specimen. Spores are ubiquitous and constantly contaminate foodstuffs.
DOI: 10.3238/arztebl.2010.0368c

Dr. med. Gerd Helmecke
Königstr. 4
53773 Hennef, Germany
Dok-Helmecke@t-online.de

Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Schulze J, Sonnenborn U: Yeasts in the gut: from commensals to infectious agents [Pilze im Darm – von kommensalen Untermietern zu Infektionserregern]. Dtsch Arztebl Int 2009; 106: 837–42. VOLLTEXT
1. Schulze J, Sonnenborn U: Yeasts in the gut: from commensals to infectious agents [Pilze im Darm – von kommensalen Untermietern zu Infektionserregern]. Dtsch Arztebl Int 2009; 106: 837–42. VOLLTEXT