ABSTRACT
An esophageal inlet patch is a congenital anomaly composed of heterotropic gastric mucosa at or just distal to upper esophageal sphincter. Most often it is asymptomatic or presents as complications of acid secretion. The diagnosis is confirmed by endoscopy with biopsy. We have presented a case of 67 years old female who complained of nausea and decreased appetite. Endoscopy showed an elevated mucosal structure with superficial ulceration in the upper third of esophagus. Histopathology confirmed presence of ectopic gastric mucosa. We have presented this case as it is not diagnosed often and it is important to identify it as it helps the treatment and rarely has a malignant potential.
ABSTRACT
Heterotopic gastric mucosa in the upper esophagus, in which the inlet patch is a salmon-colored valvet patch, is located mainly below the upper esophageal sphincter. The acid secretion and inflammation from heterotopic gastric mucosa causes laryngopharyngeal symptoms. Generally, the management of heterotopic gastric mucosa depends on the symptoms, and the condition is generally treated by proton pump inhibitor. Recently, it was reported that argon plasma coagulation (APC) is effective when medical treatment fails. A 49-year-old man and a 44-year-old woman with symptoms of globus sensation and hoarseness visited this clinic. An upper gastrointestinal endoscopy showed a flat salmon-colored patch located at the upper esophagus. The former patient failed medical treatment and the latter did not require long term medical treatment. Therefore, the patients were treated with APC, which resulted in an improvement in symptoms. APC treatment may improve the symptoms of patients with heterotopic gastric mucosa of the cervical esophagus.
Subject(s)
Adult , Female , Humans , Middle Aged , Argon , Argon Plasma Coagulation , Bays , Endoscopy, Gastrointestinal , Esophageal Sphincter, Upper , Esophagus , Gastric Mucosa , Hoarseness , Inflammation , Proton Pumps , SensationABSTRACT
La mucosa gástrica heterotópica se puede encontrar en cualquier sitio del tracto gastrointestinal, incluyendo el esófago alto. La capacidad de esta mucosa ectópica de producir ácido ha sido sugerida en escasos reportes. Reportamos 10 casos de mucosa gástrica en el esófago superior, con secreción ácida, demostrada por el monitoreo continuo y ambulatorio del pH, y la estrecha correlación de la presencia de Helicobacter pylori en la mucosa heterotópica gástrica y la antral.
Heterotopic gastric mucosa may occur throughout the gastrointestinal tract, including the upper esophagus. The capability of this ectopic mucosa to secrete acid has been suggested in scanty reports. We report ten cases of heterotopic gastric mucosa in the upper esophagus, with secretion of acid, demonstrated by continuous ambulatory pH monitoring, and the narrow correlation of the presence of Helicobacter pylori in the gastric inlet patch and the gastric antrum.
Subject(s)
Humans , Male , Female , Esophageal pH Monitoring , Gastric Mucosa , Helicobacter pyloriABSTRACT
OBJECTIVES: This study was performed to investigate the incidence and the clinical significance of inlet patch of heterotopic gastric mucosa in Koreans. This lesion can be found by close observation around the upper esophageal sphincter during upper gastrointestinal endoscopy. METHODS: From March 1, 1996 to July 8, 1996, at Kwak's hospital, randomly selected 271 patients undergoing routine diagnostic upper gastrointestinal endoscopy were included in this study. Patients with the inlet patch were confirmed by histology. Clinical symptoms observed through medical history were recorded. RESULTS: Twenty-six cases(9.6%) of the 271 patients studied had heterotopic gastric mucosa which was found at or just below the upper esophageal sphincter, varing from 3 to 30mm in diameter. It was velvety red in color and distinct from the surrounding normal squamous esophageal mucosa, resembling the Z-line at the esophagogastric junction. Parietal cells were identified in all 18 cases in which biopsy specimen contained deep glands, and chief cells were found in 14 cases. Histologically, fundic gland type was most frequent. The symptoms were relatively mild, 5 out of 6 patients who complained of throat discomfort were relieved by H2 antagonists. CONCLUSION: In Koreans the incidence of heterotopic gastric mucosa in the upper esophagus was similar to the reports from western countries unlike Barrett's esophagus. The etiology of these patches appeared to be congenital rather than acquired from reflux of gastric acid. This was supported by its location in the proximal esophagus and lack of correlation with reflux esophagitis. It must be considered as one of the differential diagnosis of a patient who complains of throat discomfort during diagnostic upper gastrointestinal endoscopy. Attention needs to be paid to find possible development of complications such as stricture and adenocarcinoma in patients with the inlet patch of heterotopic gastric mucosa.