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SUMMARY A prospective search for gastro-oesophageal candidiasis was made by histological examination ofall the biopsies taken from 465 patients endoscoped consecutively during a 12 month period. The criterion for diagnosis was the demonstration of infiltration of tissue or ulcer slough by yeasts and hyphae. Nineteen cases of candidiasis were found giving an overall incidence of 4%. There were 12 cases with oesophageal candidiasis, two with both oesophageal and gastric candidiasis, and five with gastric candidiasis. In none of the patients was candidiasis suspected before endoscopy. Symptoms referable to the candidiasis were uncommon and radiology was not helpful in diagnosis. There was associated local pathology (particularly peptic ulceration and carcinoma ofthe stomach or oesophagus) in all except two patients, which suggests that the candidiasis is usually secondary to mucosal damage. In the series, candidiasis was present in 27% of patients with oesophageal cancer, 20% of patients with gastric cancer, 16% of patients with benign gastric ulcers, and 15% of patients with oesophagitis.Until recently gastro-oesophageal candidiasis was considered to be rare and to occur mainly in debilitated or immunosuppressed patients. However, in 1976 In view of these unexpected findings we undertook a prospective study during 1980 to determine the incidence and features of gastrooesophageal candidiasis in endoscoped patients. MethodsA total of 465 patients undergoing upper gastrointestinal fibreoptic endoscopy during 1980 was included in the study. Histological sections from all endoscopic gastric and oesophageal biopsies were treated with diastase, stained with PAS, and examined for fungi. Usually four biopsies Received for publication 27 July 1981 were taken from lesions in the oesophagus and six from lesions in the stomach.The criterion for the diagnosis of candidiasis was the finding of infiltration by yeasts and hyphae of tissue or ulcer slough in histological sections of biopsies. Surface fungi were ignored. We do not consider that the demonstration of candida in smears and cultures is reliable evidence for candidiasis, as this organism is a common commensal and its presence does not imply a pathogenic role.3 Similarly, positive candida agglutination tests are not reliable, as they occur in control subjects.' Consequently serology was not done, and culture of biopsies for candida was not done routinely.Results

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