We read with interest the article by Kiesslich et al (Gut 2006;55:591) on recent advances in confocal endomicroscopy, eg, in patients with collagenous colitis. Here we demonstrate that confocal endomicroscopy can be a useful tool to detect intestinal spirochaetosis in vivo.

Intestinal spirochaetosis is characterised by the presence of spirochaetes attached to the apical cell membrane of the colonic epithelium. The prevalence in Western countries is reported as 1.1–5%. However, the prevalence is much higher among people of developing countries (11.4–64.3%) as well as homosexuals and people infected with HIV (20.6–62.5%) (reviewed by Korner and Gebbers1).

Patients with intestinal spirochaetosis can be asymptomatic or symptomatic, presenting with clinical symptoms such as chronic watery diarrhoea, rectal bleeding or abdominal pain. It is not yet clear whether spirochaetes are commensal or responsible for these symptoms.

Because of the unclear clinical relevance of intestinal spirochaetosis, …