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Objective:To study the clinical, endoscopic and histological characteristics of heterotopic gastric mucosa in upper esophagus (HGMUE).Methods:A Total of 177 patients who underwent gastroscopy and were diagnosed as having HGMUE at the Endoscopy Center of Wuhan Union Hospital from January 2017 to December 2017 were included in the study. According to the gastroesophageal reflux disease symptom questionnaire (GERD-Q) scores, patients were divided into the HGMUE group (GERD-Q<8, n=101) and GERD+HGMUE group (GERD-Q≥8, n=76). The data of clinical, endoscopic and histological characteristics were analyzed. Results:Among the 177 HGMUE cases, there were 111 males (62.71%) and 66 females (37.29%), 76 (42.94%) with GERD, and 101 (57.06%) without GERD. The most common symptom was continuous clearing throat [54.24% (96/177)], followed by foreign body sensations of throat [48.59% (86/177)], and gastroesophageal reflux symptoms such as heartburn, chest pain, indigestion, acid reflux [48.59% (86/177)]. In the HGMUE group, the occurrence rate of clearing throat was the highest [42.57% (43/101)], then foreign body sensations of throat accounted for 33.66% (34/101), and gastroesophageal reflux symptoms was 27.72% (28/101). In the HGUME+GERD group, the most common symptom was gastroesophageal reflux symptoms [76.32% (58/76)], then clearing throat [69.74% (53/76)] and foreign body sensations of throat [68.42% (52/76)]. Under gastroscopy, 177 heterotopic gastric lesions were found under gastroscopy with orange-red round, oval or elongated island like ones, most of which were flat and a few slightly protruded from the peripheral plane. There were 132 (74.58%) single-lesion cases, 38 (21.47%) 2-lesion, and 7 (3.95%) 3- or more-lesion cases; there were 37 (20.90%) small lesions (maximum diameter <0.5 cm), and 74 (41.81%) median-size lesions (maximum diameter of 0.5-1.0 cm), and 66 (37.3%) larger lesions (maximum diameter >1.0 cm). Among the 30 [16.95% (30/177)] samples of mucosal tissue, 15 [50.00% (15/30)] were mainly cardia gland, 8 [26.67% (8/30)] were mainly pyloric gland, 6 [20.00% (6/30)] were mixed type, and 1 [3.33% (1/30)] was squamous epithelium. In the immunohistochemical test, 20 cases [66.67% (20/30)] showed positive of H +/K +-ATPase, and 10 cases [33.33% (10/30)] were negative. Conclusion:HGMUE is more common in male patients, and may be combined with GERD. Among them, patients with combined GERD are more likely to develop laryngopharyngeal reflux. The heterotopic gastric mucosas lesions are orange-red round, oval or elongated island-like under gastroscopy, and most of them are flat, single and median- or large-sized. Histological types are mostly fundic glands, and H +/K +-ATPase positive is more common. It is speculated that acid secretion may be an important factor leading to throat symptoms.
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Background: Heterotopic gastric mucosa of upper esophagus (HGMUE) earned attention gradually in recent years, and the incidences of esophageal stenosis, esophageal net, dysplasia and adenocarcinoma of upper esophagus caused by HGMUE increased gradually. Aims: To summarize the clinicopathological features of HGMUE patients and analyze its possible risk factors. Methods: A total of 150 HGMUE patients from September 2018 to October 2019 at the People's Hospital of Xinjiang Autonomous Region were collected, and 150 non-HGMUE patients were served as controls. Univariate analysis and multivariate analysis were used to analyze the risk factors of HGMUE. Results: Univariate analysis showed that the incidences of alcohol consumption (P=0.029), Barrett's esophagus (P=0.003) and reflux esophagitis (P=0.001) were significantly increased in HGMUE group than in control group. Unconditional multivariate Logistic regression analysis showed that alcohol consumption, Barrett's esophagus and reflux esophagitis were the independent risk factors of HGMUE (P<0.05). Conclusions: Alcohol consumption, Barrett's esophagus and reflux esophagitis can increase the risk of HGMUE.
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Heterotopic gastric mucosa in upper esophagus (HGMUE) is a rare clinical condition, which is often associated with congenital agenesis. The diagnosis of HGMUE mainly depends on endoscopic and pathological examinations. The detection rate is increasing with the development of endoscopic techniques, however, there is no consensus on the duration of follow-up and therapeutic strategies for HGMUE and its clinical implication need to be further studied.
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Heterotopic gastric mucosa in upper esophagus (HGMUE) is a rare clinical condition,which is often associated with congenital agenesis.The diagnosis of HGMUE mainly depends on endoscopic and pathological examinations.The detection rate is increasing with the development of endoscopic techniques,however,there is no consensus on the duration of follow-up and therapeutic strategies for HGMUE and its clinical implication need to be further studied.
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Objective To investigate the diagnostic value of narrow?band imaging in patients with nonampullary duodenal superficial elevated lesions. Methods Analysis were limited to respondents diagnosed with nonampullary duodenal superficial elevated lesions on endoscopic examination. The lesion distribution, fusion, diameter, vascular and surface pattern were evaluated and compared with NBI mode according to pathological group. Results 72 cases were collected, 35 (48.61%) cases were inflammation, 17 (23.61%) cases were heterotopic gastric mucosa, 12 (16.67%) cases were gastric duodenal metaplasia and 8 (11.11%) cases were adenoma. Among the four types of duodenal lesion, solitary adenomatous lesions were observed more frequently and larger in diameter. Surface pattern of inflammatory lesions were consistent with the surrounding mucosa. Vascular pattern and fusion may be helpful to differential some superficial elevated lesions. Conclusion Nonampullary duodenal superficial elevated lesions can be identified preliminarily by NBI. Meanwhile, diagnosis accuracy and positive rate can be improved by target biopsy.
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Objective To investigate the diagnostic value of narrow?band imaging in patients with nonampullary duodenal superficial elevated lesions. Methods Analysis were limited to respondents diagnosed with nonampullary duodenal superficial elevated lesions on endoscopic examination. The lesion distribution, fusion, diameter, vascular and surface pattern were evaluated and compared with NBI mode according to pathological group. Results 72 cases were collected, 35 (48.61%) cases were inflammation, 17 (23.61%) cases were heterotopic gastric mucosa, 12 (16.67%) cases were gastric duodenal metaplasia and 8 (11.11%) cases were adenoma. Among the four types of duodenal lesion, solitary adenomatous lesions were observed more frequently and larger in diameter. Surface pattern of inflammatory lesions were consistent with the surrounding mucosa. Vascular pattern and fusion may be helpful to differential some superficial elevated lesions. Conclusion Nonampullary duodenal superficial elevated lesions can be identified preliminarily by NBI. Meanwhile, diagnosis accuracy and positive rate can be improved by target biopsy.
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Heterotopic gastric mucosa (HGM) is a rare anomaly in the small bowel and may be the cause of intussusception when it gets a lead point in the jejunum. All cases of intussusception due to intestinal HGM have been treated with surgical resection. A 5-year-old girl presented with chief complaints of vomiting and abdominal pain for 2 weeks. A computed tomography scan of the abdomen showed intussusception at the proximal jejunal loops. Three air reductions and one saline reduction were attempted without success. She continued to be symptomatic, and endoscopic evaluation was performed. Enteroscopy revealed some variable-sized polypoid mucosal lesions with erosions on the proximal jejunum. Endoscopic mucosal resection was performed using a snare. The resected tissues histologically showed a hyperplastic polyp arising from the HGM. Her symptoms did not recur within 1 year after the treatment. Our case showed that enteroscopy could be useful for the diagnosis and management of jejunal intussusception caused by HGM.
Subject(s)
Child, Preschool , Female , Humans , Abdomen , Abdominal Pain , Diagnosis , Gastric Mucosa , Intussusception , Jejunum , Polyps , SNARE Proteins , VomitingABSTRACT
Heterotopic gastric mucosa of the upper esophagus( HGMUE)is a rare esophageal disease. It is considered as a result of immature development of esophageal mucosal epithelium in embryonic period. Most of patients have no specific symptoms. The diagnosis of HGMUE is mainly based on endoscopy and biopsy. With the development of endoscopic technique,the detection rate of HGMUE is elevated and increasing attention has been paid to this disease. This article reviewed the clinical research on HGMUE.
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A mucosa gástrica heterotópica (MGH) é uma entidade rara, com malignização incomum, descrita em todo o trato gastrointestinal e fora dele. O relato é de uma mulher de 37 anos, com queixa de dor epigástrica associada a vômitos pós-prandiais com três meses de evolução, causado por MGH localizada na quarta porção duodenal. Submetida à ressecção do seguimento acometido, encontra-se em acompanhamento sem queixas ou sinais de recidiva. A MGH deve ser lembrada como um diagnóstico diferencial nos sangramentos e obstruções duodenais; a ressecção endoscópica ou cirúrgica, se factível, deve ser realizada com o intuito terapêutico.
The heterotopic gastric mucosa (HGM) is a rare event, with uncommon malignant, described throughout the gastrointestinal tract and beyond. The report is about a 37 years-old female, with epigastric pain associated with postprandial vomiting with three months of evolution, caused by HGM located in the fourth portion of the duodenum. The patient underwent resection of the affected segment and since then there has been no complaints or signs of recurrence. The HGM should be remembered as a differential diagnosis in bleeding and duodenal obstruction. The endoscopic or surgical resection, if feasible, should be performed with therapeutic purposes.
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Humans , Female , Adult , Duodenal Obstruction , Duodenum , Gastric Mucosa , Duodenal Obstruction/surgery , Gastric Mucosa/surgery , Gastric Mucosa/diagnostic imaging , Gastrointestinal HemorrhageABSTRACT
The incidence of heterotopic gastric mucosa located in the submucosa in resected stomach specimens has been reported to be 3.0 to 20.1%. Heterotopic gastric mucosa is thought to be a benign disease, which rarely becomes malignant. Heterotopic gastric mucosa exists in the gastric submucosa, and gastric cancer rarely occurs in heterotopic gastric mucosa. Since tumors are located in the normal submucosa, they appear as submucosal tumors during endoscopy, and are diagnosed through endoscopic biopsies with some difficulty. For such reasons, heterotopic gastric mucosa is mistaken as gastric submucosal tumor. Recently, two cases of early gastric cancer arising from heterotopic gastric mucosa in the gastric submucosa were treated. Both cases were diagnosed as submucosal tumors based on upper gastrointestinal endoscopy, endoscopic ultrasound, and computed tomography findings, and in both cases, laparoscopic wedge resections were performed, the surgical findings of which also suggested submucosal tumors. However, pathologic assessment of the surgical specimens led to the diagnosis of well-differentiated intramucosal adenocarcinoma arising from heterotopic gastric mucosa in the gastric submucosa.
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Adenocarcinoma , Biopsy , Endoscopy , Endoscopy, Gastrointestinal , Gastric Mucosa , Incidence , Stomach , Stomach NeoplasmsABSTRACT
Objective To evaluate the differences, including clinical symptoms, endoscopic and histopathologic findings, status of Helicobacter pylori (Hp) infection and cytokeratin (CK) expressions, be-tween Barrett esophagus (BE) and heterotopic gastric mucosa (HGM) in upper esophagus. Methods Clinical data of 152 patients with BE and 52 patients with HGM in upper esophagus diagnosed from February 2004 to September 2005 were retrospectively studied. The parameters being compared include-ed clinical manifestations, conventional and magnifying endoscopic findings, histopathological findings, Hp infection determined by rapid urease test and Warthin-Starry staining and expression of CK phenotypes detec-ted by immunohistochemistry. Results Gastro-esophngeal reflux was observed in 64. 5% of patients with BE (98/152), higher than that in patients with HGM ( 13.5%, 7/52, χ2 = 40. 36, P < 0. 01 ). Endoscopic faveolus of BE mucosa included 46 cases of spot pattern, 65 striations and 41 villiform patterns, while those of HGM were all striation patterns. The histologic classification in BE included 56 cases of fundic type, 39 junction type and 57 specialized intestinal metaplasia, while in HGM mucesa, 31 cases of fundic type, 16 junction type and 5 antrum type were diagnosed, and no goblet cells were found. Moderate and severe infil-tration of inflammatory cells in BE mucosa was 63.2% (96/152), which was significantly higher than that in HGM mucosa (15/52, 28. 8%, P<0. 01). However, no difference was found in gastric antrum inflam-mation between the two groups (44.7%, 68/152, vs. 51.9%, 27/52, P>0.05). No difference was ob-served in prevalence of Hp infection between BE and HGM groups (P >0. 05 ), either in involved mucosa or in antrum. CK7 was not expressed in HGM or normal squamons mucosa, but was expressed in BE. CK20 and CK19 were expressed in both HGM and BE, and CK13 expression was found in some BE nmcosa including gas-tric metaplesia (55/95) and intestinal metaplasia (29/57) but not in HGM mucosa. Conclusion There are differences between HGM and BE, in regarding of reflux symptoms, magnifying endoscopic findings, histo-logical types and CKs expressions, which may be indicators to make differential diagnosis.
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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.
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Adult , Female , Humans , Middle Aged , Argon , Argon Plasma Coagulation , Bays , Endoscopy, Gastrointestinal , Esophageal Sphincter, Upper , Esophagus , Gastric Mucosa , Hoarseness , Inflammation , Proton Pumps , SensationABSTRACT
Heterotopic gastric mucosa in the gallbladder is extremely unusual. In this study, we aimed to report a case of gastric heterotopia together with squamous metaplasia in the gallbladder of a 47-year-old female patient who experienced an intensive abdominal pain. He was admitted to the hospital for clinical treatment without any improvement. Ultrasonography showed a stone located in the gallbladder neck and dilatation of intrahepatic bile ducts, both hepatic ducts and common hepatic duct. Laparoscopic cholecystectomy was performed. In the microscopical examination, the epithelium of the gallbladder revealed an unspecified chronic cholecystitis. Besides, at the level of the gallbladder body, a heterotopic gastric mucosa contain chief, parietal and mucosal cells with cystic glands and squamous metaplasia was found. Actually the patient is in long-time follow-up, asymptomatic. We also review 96 other reports of HGM in the gallbladder in the international medical literature from 1934. As heterotopic tissue may promote carcinogenesis of the gallbladder, close attention should be paid to any occurrence of such lesions in this anatomical region. It appears that laparoscopic cholecystectomy may be unavoidable for patients affected by heterotopic gastric mucosa at the present time and care must be taken when a diagnosis is made based on intraoperative frozen sections.
La heterotopía de la mucosa gástrica (HGM) en vesícula biliar es extremadamente rara. En este estudio, reportamos un caso de heterotopía gástrica junto con metaplasia escamosa en vesícula biliar de un paciente femenino de 47 años que experimentó un dolor abdominal intenso. Lo admitieron al hospital para el tratamiento clínico sin ninguna mejoría. Ultrasonografía demostró un cálculo situado en el cuello de la vesícula y dilatación de conductos biliares intrahepáticos, los conductos hepáticos y conducto hepático común. Se realizó la colecistectomía por vía laparoscópica. En el exámen microscópico el epitelio reveló una colecistitis crónica inespecífica. Además, en el nivel del cuerpo de la vesícula biliar fue hallada una mucosa gástrica heterotópica con células principales, parietales, células mucosas con las glándulas enquistadas y metaplasia escamosa. El paciente está en el seguimiento a largo plazo, asintomático. Revisamos 96 informes de HGM en vesícula biliar en la literatura médica internacional a partir de 1934. El tejido heterotópico puede promover la carcinogénesis de la vesícula biliar, por lo cual se debe prestar atención a cualquier ocurrencia de tales lesiones en esta región anatómica. La colecistectomía laparoscópica puede ser inevitable para los pacientes afectados por la mucosa gástrica heterotópica actualmente y todo cuidado debe ser tomado cuando se hace un diagnóstico por secciones congeladas intraoperatorias.
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Humans , Female , Middle Aged , Cholecystolithiasis/diagnosis , Choristoma/complications , Gallbladder Diseases/pathology , Gastric Mucosa , Cholecystectomy , Cholecystolithiasis/complications , Choristoma/surgery , Gallbladder Diseases/complications , Gallbladder Diseases/surgery , Laparoscopy , Metaplasia/complications , Metaplasia/surgeryABSTRACT
Ectopic gastric mucosa is known to occur throughout the gastrointestinal tract. Ectopic gastric mucosa in the duodenum is classified into the developmental (heterotopic gastric mucosa) and acquired types (gastric metaplasia). Gastric metaplasia may be present in up to 64% of normal individuals but heterotopic gastric mucosa is quite rare. A heterotopic gastric mucosa in the duodenum may be asymptomatic but can give rise to perforation, hemorrhage, and intestinal obstruction in rare cases. Therefore, periodic endoscopic surveillance is recommended in these cases. Endoscopically, the appearance of a heterotopic gastric mucosa shows a mainly elevated lesion with multiple nodularity. We report a case of 1.5 x 1.2 cm sized polypoid lesion of the duodenum in an asymptomatic 31 year-old man. The mass was resected endoscopically and diagnosed as a heterotopic gastric mucosa.
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Adult , Humans , Duodenum , Gastric Mucosa , Gastrointestinal Tract , Hemorrhage , Intestinal Obstruction , Metaplasia , PolypsABSTRACT
BACKGROUND/AIMS: The origin of gastric mucosa outside of the stomach may be developmental (heterotopic gastric mucosa) or acquired (gastric metaplasia). The aim of this study was to evaluate the endoscopic features, according to the subtypes, of the gastric mucosa outside the stomach in the duodenum. METHODS: A total of 30 consecutive patients who underwent esophagogastroduodenoscopy from January 2002 to August 2004 and who were confirmed histopathologically as having gastric mucosa outside the stomach were retrospectively analyzed. Twenty three patients were males and seven were females. RESULTS: Nine patients had heterotopic gastric mucosa and 21 patients had gastric metaplasia. Seven patients with heterotopic gastric mucosa were asymptomatic and 2 patients had dyspepsia, whereas 21 patients with gastric metaplasia had dyspepsia. The dyspepsia rate showed a significant difference between the two groups (p<0.001). Endoscopically, the appearance of the heterotopic gastric mucosa tended to resemble area gastricae (p=0.08). However, there were no statistically differences between the two groups for the endoscopic features of the duodenum. Other abnormal lesions in stomach and duodenum appeared more frequently in the gastric metaplasia than in the heterotopic gastric mucosa (p=0.004, p<0.001). There was no difference in the prevalence of Helicobacter pylori infection between the two groups. CONCLUSIONS: There are no specific endoscopic findings to differentiate heterotopic gastric mucosa from gastric metaplasia. The presence of symptoms and the associated gastroduodenal inflammatory lesions were more prominent in the gastric metaplasia compared with the heterotopic gastric mucosa.
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Female , Humans , Male , Duodenum , Dyspepsia , Endoscopy, Digestive System , Gastric Mucosa , Helicobacter pylori , Metaplasia , Prevalence , Retrospective Studies , StomachABSTRACT
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.
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Humans , Adenocarcinoma , Barrett Esophagus , Bays , Biopsy , Constriction, Pathologic , Diagnosis, Differential , Endoscopy, Gastrointestinal , Esophageal Sphincter, Upper , Esophagitis, Peptic , Esophagogastric Junction , Esophagus , Gastric Acid , Gastric Mucosa , Incidence , Mucous Membrane , Pharynx , RabeprazoleABSTRACT
BACKGROUND: Isolated heterotopic gastric mucosa of the upper esophagus(HGME), often referred to as inlet patch, is an asyptomatic benign lesion. It may, however, cause retrosternal chest pain and dysphagea, and rarely produce complications such as ulceration and stricture. It may be suspected on characteristic finding of endoscopy, and the diagnosis is usually proved by biposy. We studied several characteristics of HGME. METHOD: From January 1996 to May 1997, endoscopy was performed on 2000 consecutive patients (1068 male, 932 female). HGME was seen 25 patients(12 male, 13 female) among 2000 patients. RESULT: Prevalence of HGME is 1.25%. There was no significant difference of the prevalence of HGME between male and female. HGME was presented as a velvety and salmon-pink patch with a distict border from the normally pale squamous cell mucosa of the esophagus, and was seen as multiple lesions in 8 patients among 25 patients. Thirty three locailzed gastric mucosal patches, varying in size 3 mm to 30 mm in the longest diameter, were detected within or just below of upper esophageal spincter in all the twenty five patients. Biopsy specimens taken from the miucosal patches demonstrated gastric mucosa. Among 25 patients with HGME, four patients complained foreign body sensation on throat or heartburn, without other diseases such as GERD, gastritis or peptic ulcer. CONCLUSION: Further studies of a large scale about pathogenesis, prevalence, and complication of HGME will be required.