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1
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Cohen DL, Bermont A, Shirin H. A systematic review of fully circumferential inlet patches (heterotopic gastric mucosa): More complicated than regular inlet patches. Indian J Gastroenterol 2025:10.1007/s12664-025-01738-y. [PMID: 40163316 DOI: 10.1007/s12664-025-01738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 01/05/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND AND OBJECTIVES Inlet patches (IP) are usually small islands of ectopic gastric mucosa found in the proximal esophagus, but rare cases of large, fully circumferential IP (FCIP) have been reported. To better understand the clinical course of patients with FCIP, we sought to perform a systematic review of all published cases. METHODS A systematic review of cases of FCIP was performed according to Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines after thorough searches of PubMed and journal databases for appropriate cases. No restrictions were placed as to article type, country of origin or publication year. RESULTS Total 30 cases of FCIP from 27 articles were identified. These included patients from 10 different countries published between 1985 and 2024. The mean age was 55.7 with 82.1% men and a mean circumferential IP length of 3.4 cm. A majority of patients were symptomatic with dysphagia and/or a history of food impactions (72.4%). Most cases involved complications from the IP, including a benign stricture/ring/web (20, 66.7%), adenocarcinoma (4, 13.3%) or ulcers/erosions (2, 6.7%). The benign strictures were usually treated by dilation together with anti-secretory medication (10, 50%) or just dilation or medication. The adenocarcinoma cases were treated by surgery (two cases) or endoscopic resection (two cases), while the ulcer cases were treated medically. All cases with follow-up reported a good clinical outcome. CONCLUSIONS Patients with FCIP are frequently symptomatic with dysphagia or food impactions and often have complications, including a stricture/ring or cancer. Despite this, they have good clinical outcomes. Given the risk of malignancy, endoscopic surveillance may be warranted.
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Affiliation(s)
- Daniel L Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, 7033001, Israel.
- The Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Anton Bermont
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, 7033001, Israel
- The Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Haim Shirin
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin, 7033001, Israel
- The Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6997801, Israel
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2
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Saeidpour Parizi A, Enhesari A, Moazed V, Shafieipour S, Shahba S, Hermis AH, Zakeri MA. Management of a patient with primary adenocarcinoma of the proximal third of the esophagus: a case report. J Med Case Rep 2025; 19:124. [PMID: 40108697 PMCID: PMC11921564 DOI: 10.1186/s13256-025-05171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 03/05/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Cervical esophageal adenocarcinoma is a rare tumor often associated with Barrett's esophagus, and its prevalence is lower than distal esophageal adenocarcinoma. Upper esophageal malignancies are usually squamous cell carcinomata; about 5% of these cases are seen during upper gastrointestinal endoscopy. CASE PRESENTATION We present a patient (a 39-year-old Iranian man) with invasive adenocarcinoma of the proximal third of the esophagus, who was referred to the hospital with no endoscopic or histopathologic evidence of Barrett's esophagus. We discuss the probable cause of this tumor and treatment options and emphasize the importance of recognizing and managing this rare disease. CONCLUSIONS This case highlights the rarity of this adenocarcinoma and emphasizes the potential of chemotherapy as a standalone treatment, as well as the need for personalized therapeutic strategies and further research for the management of esophageal cancer.
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Affiliation(s)
- Ali Saeidpour Parizi
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Ahmad Enhesari
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Vahid Moazed
- Hematology and Oncology, Hematology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Sara Shafieipour
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Samira Shahba
- Department of Biotechnology, School of Medicine, Semnan University of Medical Science, Semnan, Iran
| | - Alaa Hamza Hermis
- Nursing College, Al-Mustaqbal University, 51001, Hillah, Babil, Iraq
| | - Mohammad Ali Zakeri
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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3
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Takubo K, Shepherd NA. Normal embryology, foetal development and developmental abnormalities. MORSON AND DAWSON'S GASTROINTESTINAL PATHOLOGY 2024:13-20. [DOI: 10.1002/9781119423195.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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4
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Bahdi F, Tamai R, Lu DY, Eshtiaghpour DD, Thaker AM, Sedarat A. Curative Resection of T1a Inlet Patch Adenocarcinoma With Traction-Assisted Endoscopic Submucosal Dissection. ACG Case Rep J 2024; 11:e01284. [PMID: 38371470 PMCID: PMC10871786 DOI: 10.14309/crj.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Esophageal inlet patch (EIP) adenocarcinoma is extremely rare. We present a case of a 58-year-old man who underwent a diagnostic esophagogastroduodenoscopy for dysphagia and found to have a 2 cm polypoid mass arising from an EIP. Biopsies and staging were consistent with T1aN0M0 EIP adenocarcinoma. While surgical resection was the main method of treatment of these lesions, very few case reports have shown that endoscopic resection can successfully remove these lesions. After multidisciplinary discussion, the patient underwent curative traction-assisted endoscopic submucosal dissection-which is the first known case report to highlight the success of this technique.
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Affiliation(s)
- Firas Bahdi
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Robert Tamai
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - David Y. Lu
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Daniel D. Eshtiaghpour
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Adarsh M. Thaker
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Alireza Sedarat
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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5
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Khatri R, Patel J, Song J, Malik Z, Smith MS, Parkman HP. Esophageal Inlet Patch: Association with Barrett's Esophagus. Dig Dis Sci 2023; 68:3671-3678. [PMID: 37452980 DOI: 10.1007/s10620-023-08030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Esophageal inlet patch (IP) with heterotopic gastric mucosa is an incidental finding on esophagogastroduodenoscopy (EGD). Although IP is thought to be embryologic in nature, IP has been associated with Barrett's esophagus (BE). AIMS The aim of this study was to compare prevalence, symptoms, demographic factors, and esophageal testing in patients with IP and BE. METHODS We retrospectively analyzed endoscopic findings of EGDs, high-resolution esophageal manometry and esophageal pH impedance studies from January 2010 to January 2021 at a single academic medical center. Patients were grouped by presence or absence of IP and BE. RESULTS Of 27,498 patients evaluated, 1.3% had endoscopic evidence of IP and 4.9% had BE. Of 362 patients with IP, 17.1% had BE; of 1356 patients with BE, 4.6% had IP. Both IP and BE patients presented primarily with heartburn and/or regurgitation. Patients with BE and/or IP were older and had higher BMI than those without (p < 0.001). Mean lower esophageal sphincter pressure was lower and mean acid exposure time (AET) was higher in patients with IP and/or BE than those without (p < 0.05). CONCLUSIONS Our study reports an IP prevalence of 1.3%, with 17.1% patients having concomitant BE; and a BE prevalence of 4.9%, with 4.6% also having IP. Patients with IP alone presented with similar symptoms to patients with concomitant BE. Esophageal function testing showed that patients with either IP or BE had decreased LES pressures and increased esophageal AET. During endoscopy, patients found to have one of these findings should be carefully examined for the other.
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Affiliation(s)
- Rishabh Khatri
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA.
- Gastroenterology Section, Temple University School of Medicine, Parkinson Pavilion, 8th Floor, Philadelphia, PA, 19140, USA.
| | - Jay Patel
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Jun Song
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Zubair Malik
- Department of Gastroenterology, Temple University Health System, Philadelphia, PA, USA
| | - Michael S Smith
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai West & Mount Sinai Morningside Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Henry P Parkman
- Department of Gastroenterology, Temple University Health System, Philadelphia, PA, USA
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Romańczyk M, Budzyń K, Romańczyk T, Lesińska M, Koziej M, Hartleb M, Waluga M. Heterotopic Gastric Mucosa in the Proximal Esophagus: Prospective Study and Systematic Review on Relationships with Endoscopic Findings and Clinical Data. Dysphagia 2023; 38:629-640. [PMID: 35809096 DOI: 10.1007/s00455-022-10492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
Cervical inlet patches (CIP) are common endoscopic findings with uncertain pathogenesis and clinical significance. We aimed to perform a systematic review and prospective study of clinical data and endoscopic findings related to CIP. It was a prospective single-center study conducted between 10/01/2017 and 9/01/2018. Forty patients with histopathologically confirmed CIP were compared with 222 individuals in the reference group. The systematic review was executed in accordance with the PRISMA guideline. Alcohol consumption tended to be higher among patients with CIP (3.0 ± 4.6 vs. 1.9 ± 5.0 standard drinks/week CIP patients and reference group, respectively; p < 0.001). Dysphagia was more frequent among patients with CIP (25% vs. 1.4%, CIP patients and reference group, respectively; p < 0.001), and sore throat and hoarseness were less frequent in patients with CIP (17.5% vs. 26.6% CIP patients and reference group, respectively; p < 0.01). In the multivariate regression analysis, the only risk factor of CIP occurrence was dysphagia (OR 21.9, 95%CI 4.9-98.6; p < 0.001). Sore throat and hoarseness were a reverse-risk factor of CIP diagnosis (OR 0.3, 95%CI 0.1-0.93; p = 0.04). Clinical data and coexisting endoscopic findings were not related to CIP. In the presented study, dysphagia was related to CIP occurrence, and sore throat and hoarseness tended to be less frequent among patients with CIP.
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Affiliation(s)
- Marcin Romańczyk
- Endoterapia, H-T. Centrum Medyczne, Aleja Bielska 105, 43-100, Tychy, Poland
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Budzyń
- Endoterapia, H-T. Centrum Medyczne, Aleja Bielska 105, 43-100, Tychy, Poland.
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Tomasz Romańczyk
- Endoterapia, H-T. Centrum Medyczne, Aleja Bielska 105, 43-100, Tychy, Poland
- Department of Gastroenterology, Wyższa Szkoła Techniczna W Katowicach, Katowice, Poland
| | - Magdalena Lesińska
- Endoterapia, H-T. Centrum Medyczne, Aleja Bielska 105, 43-100, Tychy, Poland
- Department of Gastroenterology, Wyższa Szkoła Techniczna W Katowicach, Katowice, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Hartleb
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marek Waluga
- Endoterapia, H-T. Centrum Medyczne, Aleja Bielska 105, 43-100, Tychy, Poland
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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7
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Ito M, Dobashi A, Komori M, Sugimura S, Aizawa D, Takahashi K, Tanishima Y, Sumiyama K. Lymph node metastasis after endoscopic submucosal dissection of a superficial esophageal adenocarcinoma arising from the ectopic gastric mucosa of the cervical esophagus: A case report. DEN OPEN 2023; 3:e214. [PMID: 36825033 PMCID: PMC9942940 DOI: 10.1002/deo2.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
Esophageal adenocarcinoma derived from the ectopic gastric mucosa of the cervical esophagus is very rare. Little is known about the efficacy of endoscopic treatment of these superficial lesions. Herein, we report the first case of lymph node metastasis after endoscopic submucosal dissection of a lesion with invasion into the muscularis mucosa. A 46-year-old man underwent esophagogastroduodenoscopy during a health checkup. Endoscopy revealed a 10-mm-sized nodular and a 5-mm-sized depressed lesion within the ectopic gastric mucosa of the cervical esophagus. The biopsy specimen confirmed the presence of adenocarcinoma. The entire ectopic gastric mucosa was resected by endoscopic submucosal dissection, and pathological examination showed invasion of the muscularis mucosa. A follow-up computed tomography scan revealed lymph node metastasis 12 months post-treatment. The patient underwent surgical mediastinal lymphadenectomy. The patient has been regularly followed up with a computed tomography scan and endoscopy for 2 years post-surgery with no evidence of recurrence. Close follow-up or additional treatment after endoscopic submucosal dissection should be considered and discussed with the patient if invasion into the muscularis mucosa is observed on pathological examination.
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Affiliation(s)
- Mamoru Ito
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Akira Dobashi
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Moe Komori
- Department of Gastroenterology and HepatologyThe Jikei University School of MedicineTokyoJapan
| | - Shun Sugimura
- Department of Gastroenterology and HepatologyThe Jikei University School of MedicineTokyoJapan
| | - Daisuke Aizawa
- Department of PathologyThe Jikei University School of MedicineTokyoJapan
| | - Keita Takahashi
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | | | - Kazuki Sumiyama
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
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8
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Patel A, Ajumobi AB. Esophageal Stricture: An Uncommon Complication of Cervical Inlet Patch. J Investig Med High Impact Case Rep 2023; 11:23247096231201024. [PMID: 37840294 PMCID: PMC10578063 DOI: 10.1177/23247096231201024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 10/17/2023] Open
Abstract
Esophageal heterotopic gastric mucosal patches (HGMP), also known as cervical inlet patches (CIP), is a rare but underdiagnosed condition characterized by the presence of salmon-colored, velvety mucosa located in the proximal esophagus, distal to the upper esophageal sphincter. The incidence of CIP ranges from 3% to 10% in adults, and its endoscopic appearance is characterized by a flat or slightly raised salmon-colored patch. In this case, we report a 78-year-old man who presented with symptoms of laryngopharyngeal reflux and dysphagia. An esophagogastroduodenoscopy showed a flat area of salmon-colored patch between 17 and 20 cm from the incisors, suggestive of a CIP complicated by stricture. The biopsy results showed an oxyntic-type mucosa lined with columnar cells consistent with an inlet patch. Esophageal dilation was done with a savory dilator with no resistance at 18 mm. The patient was placed on maintenance acid suppression therapy with proton-pump inhibitors and reported complete resolution of symptoms at the 1-month follow-up.
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Affiliation(s)
| | - Adewale B. Ajumobi
- Eisenhower Health, Rancho Mirage, CA, USA
- University of California Riverside, USA
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Kishimoto K, Shibagaki K, Nonomura S, Sumi S, Fukuda N, Takahashi Y, Kotani S, Okimoto E, Oshima N, Kawashima K, Ishimura N, Ishihara S. Heterotopic Gastric Mucosa in Middle Esophagus Complicated with Esophageal Ulcers. Intern Med 2022; 61:2735-2740. [PMID: 35228416 PMCID: PMC9556244 DOI: 10.2169/internalmedicine.8705-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/04/2022] [Indexed: 12/28/2022] Open
Abstract
Heterotopic gastric mucosa (HGM) of esophagus, primarily occurring in cervical esophagus, is usually asymptomatic. A healthy woman (mid-40s) with postprandial heartburn was diagnosed with middle esophageal HGM and esophageal ulcers by esophagogastroduodenoscopy. Using 8-channel pH monitoring, a sensor near the HGM area detected postprandial acid phase (pH 3-4), while areas adjacent to the proximal and distal sensors were neutral, suggesting acid secretion from the HGM. A biopsy showed fundic gland tissue expressing H+/K+-ATPase and pepsinogen-I. Oral vonoprazan improved the clinical symptoms and endoscopic findings. This is the first report using 8-channel pH monitoring to diagnose extremely rare middle esophageal HGM.
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Affiliation(s)
- Kenichi Kishimoto
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | | | - Saya Nonomura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Shohei Sumi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | | | - Yusuke Takahashi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Eiko Okimoto
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Naoki Oshima
- Department of Endoscopy, Shimane University Hospital, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
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Merca R, Richter B. Life-threatening gastrointestinal bleeding caused by jejunal heterotopic gastric mucosa in an adult dog: a rare case report. BMC Vet Res 2022; 18:315. [PMID: 35974373 PMCID: PMC9380381 DOI: 10.1186/s12917-022-03415-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Heterotopic gastric mucosa has been scarcely reported in the veterinary literature. Its presence can be asymptomatic or associated with various clinical signs ranging from apathy, vomiting, to abdominal pain. This report illustrates the presence of heterotopic gastric mucosa in the jejunum of an adult dog. It is the first to describe severe anemia, requiring acute blood transfusion, following intestinal hemorrhage caused by heterotopic gastric mucosa. Case presentation A twelve-year-old, intact male Maltese dog was presented with a history of apathy, vomiting and anemia. The dog was on a strict diet for recurrent diarrhea, food intolerance and skin allergy. Clinical examination revealed severe anemic mucous membranes and painful abdominal palpation. Blood examination confirmed severe regenerative anemia. Ultrasonography showed an intestinal neoplasm, gall bladder sludge and non-homogeneous liver parenchyma. Three-view thoracic radiographs failed to show any metastatic lesions or enlarged lymph nodes. After initial stabilization and blood transfusion, a midline exploratory laparotomy was performed. Three different masses were found in the jejunum. Resection and anastomosis of approximately 40 cm of jejunum was performed, followed by liver and lymph node biopsy and placement of an esophagostomy tube. Two days after surgery the dog started to clinically improve and was discharged from the hospital on the sixth day after surgery. Histopathology revealed the intestinal masses to be heterotopic gastric mucosa associated with intramural cystic distensions, multifocal ulceration and bleeding into the intestinal lumen. Two years after surgery, the dog did not have a recurrence of anemia or gastrointestinal signs. Conclusions This case demonstrates that heterotopic gastric mucosa can be considered one of the differential diagnoses in case of severe anemia due to gastrointestinal hemorrhage and suspected intestinal tumors. Although in most described cases in literature the finding seems to be incidental on necropsy, our report shows that heterotopic gastric mucosa can be the etiology of life-threatening signs. In addition, because no recurrent diarrhea episodes occurred after surgical resection of the ectopic tissue, it is likely that the heterotopic gastric mucosa was the cause of the food intolerance signs in this dog.
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Affiliation(s)
- Roxana Merca
- Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Barbara Richter
- Department for Pathobiology, Institute of Pathology, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria
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11
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Yin Y, Li H, Feng J, Zheng K, Yoshida E, Wang L, Wu Y, Guo X, Shao X, Qi X. Prevalence and Clinical and Endoscopic Characteristics of Cervical Inlet Patch (Heterotopic Gastric Mucosa): A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2022; 56:e250-e262. [PMID: 33780217 DOI: 10.1097/mcg.0000000000001516] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cervical inlet patch (CIP), also called gastric inlet patch, is a heterotopic columnar mucosal island located in the cervical esophagus, which has been under-recognized by clinicians. AIM We conducted a systemic review and meta-analysis to explore the prevalence and clinical and endoscopic characteristics of CIP. MATERIALS AND METHODS Studies were searched through the PubMed, EMBASE, and Cochrane Library databases. The prevalence of CIP with 95% confidence interval (CI) was pooled by using a random-effect model. The association of CIP with demographics, clinical presentations, and endoscopic features was evaluated by odds ratios (ORs). RESULTS Fifty-three studies including 932,777 patients were eligible. The pooled prevalence of CIP was 3.32% (95% CI=2.86%-3.82%). According to the endoscopic mode, the pooled prevalence of CIP was higher in studies using narrow-band imaging than in those using white light and esophageal capsule endoscopy (9.34% vs. 2.88% and 0.65%). The pooled prevalence of CIP was higher in studies where the endoscopists paid specific attention to the detection of this lesion (5.30% vs. 0.75%). CIP was significantly associated with male (OR=1.24, 95% CI=1.09-1.42, P=0.001), gastroesophageal reflux disease (OR=1.32, 95% CI=1.04-1.68, P=0.03), reflux symptoms (OR=1.44, 95% CI=1.14-1.83, P=0.002), dysphagia (OR=1.88, 95% CI=1.28-2.77, P=0.001), throat discomfort (OR=4.58, 95% CI=1.00-21.02, P=0.05), globus (OR=2.95, 95% CI=1.52-5.73, P=0.001), hoarseness (OR=4.32, 95% CI=1.91-9.78, P=0.0004), cough (OR=3.48, 95% CI=1.13-10.72, P=0.03), Barrett's esophagus (OR=2.01, 95% CI=1.37-2.94, P=0.0003), and esophagitis (OR=1.62, 95% CI=1.27-2.07, P=0.0001). CONCLUSION CIP appears to be common by using narrow-band imaging, especially if the endoscopists would like to pay attention to the detection of this lesion. CIP is clearly associated with acid-related symptoms and Barrett's esophagus.
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Affiliation(s)
- Yue Yin
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Jinzhou Medical University, Jinzhou
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Ji Feng
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Kexin Zheng
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Jinzhou Medical University, Jinzhou
| | - Eric Yoshida
- Department of Medicine, Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | - Le Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Dalian Medical University, Dalian, People's Republic of China
| | - Yanyan Wu
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Jinzhou Medical University, Jinzhou
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Xiaodong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
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Romańczyk M, Romańczyk T, Lesińska M, Romańczyk A, Hartleb M, Waluga M. Influence of narrow-band imaging (NBI) and enhanced operator's attention during esophagus inspection on cervical inlet patches detection. Adv Med Sci 2021; 66:170-175. [PMID: 33640715 DOI: 10.1016/j.advms.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Heterotopic gastric mucosa in the upper esophagus (cervical inlet patches - CIP) may be easily missed during esophagogastroduodenoscopy (EGD) due to low awareness of this usually, but not invariably, benign lesion. Narrow-band imaging (NBI) emphasizes contrast between normal esophageal mucosa and CIP. The purpose of this study was to investigate how NBI use and enhanced attention of operator during inspection of upper esophagus impacts cervical inlet patch detection rate (CIPDR). MATERIALS AND METHODS This is a prospective, randomized study in which we enrolled 1000 patients, qualified for diagnostic EGD. The trial was divided into two parts; the first, when 6 operators performed EGD with standard attention (SA), and the second, when the same operators were asked to step up with attention at CIP (enhanced attention - EA). In both parts of the study, patients were randomized to NBI and white light endoscopy (WLE) in 1:1 ratio. The study is registered in ClinicalTrials.gov (No. NCT03015571). RESULTS Differences in CIPDR between WLE and NBI in SA and EA were not statistically different (5.6% vs 7.6%; p = 0.3, and 7.6% vs 11.6%; p = 0.1, respectively). In multivariate regression analysis, the only factors improving CIPDR were NBI with EA (NBIEA, OR 3.31; 95%CI 1.57-6.98; p = 0.003) and sedation (OR 1.97; 95%CI 1.27-3.05; p = 0.002). CONCLUSIONS The use of NBI combined with EA significantly improves CIPDR.
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Burns EA, Kasparian S, Khan U, Abdelrahim M. Pancreatic adenocarcinoma with early esophageal metastasis: A case report and review of literature. World J Clin Oncol 2020; 11:83-90. [PMID: 32133277 PMCID: PMC7046924 DOI: 10.5306/wjco.v11.i2.83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/23/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic adenocarcinoma is an aggressive malignancy with a high propensity to metastasize. Esophageal metastasis manifesting as dysphagia is rarely reported in the literature and has not to our knowledge been reported prior to the appearance of the primary disease.
CASE SUMMARY A patient presented with progressive dysphagia to solids and a persistent earache. Computed tomography of the neck and chest revealed a 3.0 cm × 1.8 cm heterogeneous mass originating from the upper third of the esophagus, necrotic cervical and supraclavicular lymphadenopathy, and bilateral pulmonary nodules. She underwent a core needle biopsy of a right cervical node, which suggested a well-differentiated adenocarcinoma of unknown primary. She had an upper endoscopy with biopsy of the esophageal mass suggestive of a well-differentiated adenocarcinoma. Positron emission tomography imaging revealed increased uptake in the esophageal mass, cervical, and mediastinal lymph nodes. She was started on folinic acid, fluorouracil, and oxaliplatin. Prior to initiation of cycle 8, the patient was found to have a pancreatic body mass that was not present on prior radiographic imaging, confirmed by endoscopic ultrasonography and biopsy to be pancreatic adenocarcinoma. CA19-9 was > 10000 U/mL, suggesting a primary pancreaticobiliary origin.
CONCLUSION Esophageal metastasis diagnosed before primary pancreatic adenocarcinoma is rare. This case highlights the profound metastatic potential of pancreatic adenocarcinoma.
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Affiliation(s)
- Ethan Alexander Burns
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, United States
| | - Saro Kasparian
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, United States
| | - Usman Khan
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX 77030, United States
| | - Maen Abdelrahim
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX 77030, United States
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14
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Sato H, Takeuchi M, Terai S. Endoscopic diverticulectomy for Zenker's diverticulum with heterotopic gastric mucosa. Dig Endosc 2020; 32:145. [PMID: 31529715 DOI: 10.1111/den.13529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Manabu Takeuchi
- Division of Gastroenterology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata, Japan
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15
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The Prevalence of Heterotopic Gastric Mucosa of the Proximal Esophagus and the Relationship Between Clinical and Endoscopic Findings. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.626167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
PURPOSE OF REVIEW The purpose of this review is to assess recent literature on the clinical relevance of the gastric inlet patch with particular focus on endoscopic diagnosis and treatment, the relationship of the inlet patch to laryngopharyngeal reflux disease and the association of proximal esophageal adenocarcinoma with inlet patch. RECENT FINDINGS Recent studies suggest endoscopic diagnosis of inlet patch increases with endoscopist awareness (up to 10-fold) and when using enhanced imaging techniques such as narrow band imaging (up to three-fold). The literature remains mixed on the association of inlet patch with laryngopharyngeal symptoms or globus sensation. Studies of endoscopic ablation, using argon plasma coagulation or radiofrequency ablation have shown improved laryngopharyngeal reflux symptom scores posttreatment. Proximal esophageal adenocarcinomas are rare but often associated with inlet patch when they occur. Case studies have described endoscopic resection of malignant lesions related to inlet patch, using endoscopic mucosal resection or submucosal dissection. SUMMARY Prospective, multicenter studies of symptom association with inlet patch using validated symptom questionnaires and blinded sham-controlled treatments are needed to further clarify the role of such treatments, which to date are limited to a small numbers of centers with a special interest.
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17
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Ciocalteu A, Popa P, Ionescu M, Gheonea DI. Issues and controversies in esophageal inlet patch. World J Gastroenterol 2019; 25:4061-4073. [PMID: 31435164 PMCID: PMC6700698 DOI: 10.3748/wjg.v25.i30.4061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
The proximal esophagus is rarely examined, and its inspection is often inadequate. Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus, a region in which their prevalence is likely underestimated. Various studies have reported correlations between these esophageal marks with different issues such as Barrett's esophagus, but these findings remain controversial. Conflicting reports complicate the process of interpreting the clinical features of esophageal inlet patches and underestimate their importance. Unfortunately, the limited clinical data and statistical analyses make reaching any conclusions difficult. It is hypothesized that inlet patches are correlated with various esophageal and extraesophageal symptoms, diagnoses and the personalized therapeutic management of patients with inlet patches as well as the differential diagnosis for premalignant lesions or early cancers. Due to its potential underdiagnosis, there are no consensus guidelines for the management and follow up of inlet patches. This review focuses on questions that were raised from published literature on esophageal inlet patches in adults.
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Affiliation(s)
- Adriana Ciocalteu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Petrica Popa
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Mircea Ionescu
- Department of Anesthesiology and Intensive Care, Emergency County Hospital of Craiova, Craiova 200642, Romania
| | - Dan Ionut Gheonea
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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18
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Mounajjed T. Drug-induced Injury, Infections, and Congenital and Miscellaneous Disorders. SURGICAL PATHOLOGY OF NON-NEOPLASTIC GASTROINTESTINAL DISEASES 2019:81-118. [DOI: 10.1007/978-3-030-15573-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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Rusu R, Ishaq S, Wong T, Dunn JM. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol 2018; 9:214-220. [PMID: 30046427 PMCID: PMC6056090 DOI: 10.1136/flgastro-2017-100855] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/25/2017] [Accepted: 10/18/2017] [Indexed: 02/04/2023] Open
Abstract
The cervical inlet patch is an island of heterotopic gastric mucosa, most commonly found in the proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus sensation. This has led to a change in the Rome IV criteria for globus management, with emphasis on ruling out the condition. Proton pump inhibitors are often ineffective in resolving symptoms. Endoscopic studies on the use of ablative techniques, most recently radiofrequency ablation (RFA), have shown promise in reversing the CIP to mormal squamous mucosa, with subsequent symtpomatic resolution. The aim of this review is to update on the investigation and management of the CIP.
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Affiliation(s)
- Radu Rusu
- Department of Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sauid Ishaq
- Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK
| | - Terry Wong
- Department of Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Jason M Dunn
- Department of Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
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20
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Harrison LJ, Kenwright D, Stringer MD. Esophageal heterotopic gastric mucosa in esophageal atresia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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21
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Kristo I, Rieder E, Paireder M, Schwameis K, Jomrich G, Dolak W, Parzefall T, Riegler M, Asari R, Schoppmann SF. Radiofrequency ablation in patients with large cervical heterotopic gastric mucosa and globus sensation: Closing the treatment gap. Dig Endosc 2018; 30:212-218. [PMID: 28884487 DOI: 10.1111/den.12959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Symptomatic cervical heterotopic gastric mucosa, also known as cervical inlet patch (CIP), may present in various shapes and causes laryngopharyngeal reflux (LPR). Unfortunately, argon plasma coagulation, standard treatment of small symptomatic CIP, is limited in large CIP mainly because of concerns of stricture formation. Therefore, we aimed to investigate radiofrequency ablation (RFA), a novel minimally invasive ablation method, in the treatment of CIP focusing on large symptomatic patches. METHODS Consecutive patients with macroscopic and histological evidence of large (≥20 mm diameter) heterotopic gastric mucosa were included in this prospective trial. Primary outcome was complete macroscopic and histological eradication rate of CIP. Secondary outcome measures were symptom improvement, quality of life, severity of LPR and adverse events. RESULTS Ten patients (females, n = 5) underwent RFA of symptomatic CIP. Complete histological and macroscopic eradication of CIP was observed in 80% (females, n = 4) of individuals after two ablations. Globus sensations significantly improved from median visual analog scale score 8 (5-9) at baseline to 1.5 (1-7) after first ablation and 1 (1-2) after final evaluation (P < 0.001). Mental health scores significantly increased from 41.4 (± 8.5) to 54.4 (± 4.4) after RFA (P = 0.007). LPR improved significantly (P = 0.005) with absence of strictures after a mean follow up of 1.9 (± 0.5) years. CONCLUSIONS This is the first study on RFA focusing on therapy of large symptomatic heterotopic gastric mucosa. Hereby, we demonstrate that this new technique can be successfully implemented in patients where treatment was limited so far (NCT03023280).
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Affiliation(s)
- Ivan Kristo
- Departments of Surgery, Medical University of Vienna, Vienna, Austria
| | - Erwin Rieder
- Departments of Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Paireder
- Departments of Surgery, Medical University of Vienna, Vienna, Austria
| | - Katrin Schwameis
- Departments of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerd Jomrich
- Departments of Surgery, Medical University of Vienna, Vienna, Austria
| | - Werner Dolak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Parzefall
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | | | - Reza Asari
- Departments of Surgery, Medical University of Vienna, Vienna, Austria
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22
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Orosey M, Amin M, Cappell MS. A 14-Year Study of 398 Esophageal Adenocarcinomas Diagnosed Among 156,256 EGDs Performed at Two Large Hospitals: An Inlet Patch Is Proposed as a Significant Risk Factor for Proximal Esophageal Adenocarcinoma. Dig Dis Sci 2018; 63:452-465. [PMID: 29249048 DOI: 10.1007/s10620-017-4878-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND An association between inlet patches and proximal esophageal adenocarcinomas is currently suspected because of numerous case reports of simultaneous occurrence of both diseases. AIMS To analyze whether inlet patches are significantly associated with proximal esophageal adenocarcinomas in a large population. METHODS Computerized search of pathology and EGD reports revealed 398 cases of esophageal adenocarcinomas among 156,236 EGDs (performed on 106,510 patients) diagnosed by histopathology performed at Royal Oak/Troy, William Beaumont Hospitals, 2003-2016. Adenocarcinomas localized as distal, middle, or proximal; and characterized as associated versus unassociated with inlet patches. Medical records were reviewed. Endoscopic photographs, radiologic images, and pathologic slides were re-reviewed. Two researchers independently performed systematic computerized literature searches; cases of simultaneous diseases identified by consensus. RESULTS Adenocarcinoma locations included: distal-381, middle-14, and proximal esophagus-3. Five patients had inlet patches with esophageal adenocarcinomas located at: distal-2, middle-0, and proximal esophagus-3 (relative frequency of inlet patches with cancers of distal/middle esophagus = 2/395 [.5%] vs. proximal esophagus = 3/3 [100%], p < .000001, 95% OR CI > 50.1, Fisher's exact test). Cases of proximal esophageal adenocarcinomas within inlet patches included: (1) Seventy-eight-year-old man presented with dysphagia. Neck CT showed proximal esophageal mass. EGD revealed semi-circumferential, multinodular, 3.0 × 1.5 cm mass within inlet patch. Histopathology of biopsies revealed moderately-to-poorly differentiated adenocarcinoma. Patient received chemoradiotherapy and expired 2 years later. (2) Seventy-nine-year-old man presented with anorexia and weight loss. EGD demonstrated proximal esophageal mass within inlet patch. Histopathology of biopsies revealed poorly differentiated, signet ring cell adenocarcinoma. Chest CT revealed 3.4 × 2.1-cm-proximal esophageal mass. Patient expired 4 months later. (3) Sixty-year-old man presented with dysphagia. EGD revealed 4-cm-long, semi-circumferential, proximal esophageal mass within inlet patch. Histopathology of biopsies revealed poorly differentiated adenocarcinoma. Patient underwent emergency esophagectomy for esophageal perforation 2 weeks after initiating chemoradiotherapy, and died shortly thereafter. Literature review revealed 39 cases of simultaneous disease. STUDY LIMITATIONS Potential underreporting by endoscopists of inlet patches at EGD. CONCLUSIONS Study supplements 39 previously reported cases of simultaneous disease, by adding three new cases, and by novel report of statistically significant association between these two entities, which has important implications in the pathophysiology of proximal esophageal adenocarcinoma.
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Affiliation(s)
- Molly Orosey
- Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
| | - Mitual Amin
- Department of Pathology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
- Department of Pathology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, 48073, USA
| | - Mitchell S Cappell
- Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA.
- Division of Gastroenterology and Hepatology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, 48073, USA.
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23
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Peitz U, Vieth M, Evert M, Arand J, Roessner A, Malfertheiner P. The prevalence of gastric heterotopia of the proximal esophagus is underestimated, but preneoplasia is rare - correlation with Barrett's esophagus. BMC Gastroenterol 2017; 17:87. [PMID: 28701149 PMCID: PMC5508702 DOI: 10.1186/s12876-017-0644-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The previously reported prevalence of gastric heterotopia in the cervical esophagus, also termed inlet patch (IP), varies substantially, ranging from 0.18 to 14%. Regarding cases with adenocarcinoma within IP, some experts recommend to routinely obtain biopsies from IP for histopathology. Another concern is the reported relation to Barrett's esophagus. The objectives of the study were to prospectively determine the prevalence of IP and of preneoplasia within IP, and to investigate the association between IP and Barrett's esophagus. METHODS 372 consecutive patients undergoing esophagogastroduodenoscopy were carefully searched for the presence of IP. Biopsies for histopathology were targeted to the IP, columnar metaplasia of the lower esophagus, gastric corpus and antrum. Different definitions of Barrett's esophagus were tested for an association with IP. RESULTS At least one IP was endoscopically identified in 53 patients (14.5%). Histopathology, performed in 46 patients, confirmed columnar epithelium in 87% of cases, which essentially presented corpus and/or cardia-type mucosa. Intestinal metaplasia was detected in two cases, but no neoplasia. A previously reported association of IP with Barrett's esophagus was weak, statistically significant only when short segments of cardia-type mucosa of the lower esophagus were included in the definition of Barrett's esophagus. CONCLUSIONS The prevalence of IP seems to be underestimated, but preneoplasia within IP is rare, which does not support the recommendation to regularly obtain biopsies for histopathology. Biopsies should be targeted to any irregularities within the heterotopic mucosa. The correlation of IP with Barrett's esophagus hints to a partly common pathogenesis.
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Affiliation(s)
- Ulrich Peitz
- Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44, D 30120, Magdeburg, Germany. .,Clinic of Gastroenterology, Raphaelsklinik, Münster, Germany.
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Matthias Evert
- Institute of Pathology, University Regensburg, Regensburg, Germany
| | - Jovana Arand
- Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44, D 30120, Magdeburg, Germany
| | - Albert Roessner
- Institute of Pathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter Malfertheiner
- Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44, D 30120, Magdeburg, Germany
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24
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Gastric inlet patches in the cervical esophagus: what they are, what they cause, and how they can be treated. Gastrointest Endosc 2016; 84:1027-1029. [PMID: 27855791 DOI: 10.1016/j.gie.2016.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/11/2016] [Indexed: 02/08/2023]
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Hudspeth VR, Smith DS, Pacicco T, Lewis JJ. Successful endoscopic resection of adenocarcinoma arising in an esophageal inlet patch. Dis Esophagus 2016; 29:880-882. [PMID: 24961886 DOI: 10.1111/dote.12249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An esophageal inlet patch is an area of heterotopic gastric mucosa in the upper esophagus. Most are asymptomatic and found incidentally. There are only 43 case reports of adenocarcinoma arising in an inlet patch, and the majority of these underwent surgical resection. We present the case of a 77-year-old man with intramucosal adenocarcinoma of the cervical esophagus, found within an esophageal inlet patch, staged T1a N0 Mx by endosonographic criteria. He was successfully treated with endoscopic therapy alone. One year following the endoscopic resection, there are no signs of residual or recurrent disease. This case highlights that adenocarcinoma can be a rare complication of an esophageal inlet patch, and that if found early, endoscopic resection appears safe and efficacious.
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Affiliation(s)
- V R Hudspeth
- Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
| | - D S Smith
- Gastroenterology, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - T Pacicco
- Gastroenterology, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Jason J Lewis
- Gastroenterology, Carolinas Medical Center, Charlotte, North Carolina, USA
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Lupu VV, Ignat A, Paduraru G, Mihaila D, Burlea M, Ciubara A. Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report. Medicine (Baltimore) 2015; 94:e1722. [PMID: 26496283 PMCID: PMC4620775 DOI: 10.1097/md.0000000000001722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Heterotopic gastric mucosa (HGM) of the esophagus is a congenital anomaly consisting of ectopic gastric mucosa. It may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. The diagnosis of HGM is confirmed via endoscopy with biopsy. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. HGM located in the distal esophagus needs differentiation from Barrett's esophagus. Barrett's esophagus is a well-known premalignant injury for adenocarcinoma of the esophagus. Malignant progression of HGM occurs in a stepwise pattern, following the metaplasia-dysplasia-adenocarcinoma sequence.We present a rare case of a teenage girl with HGM located in the distal esophagus, associated with chronic gastritis and biliary duodenogastric reflux. Endoscopy combined with biopsies is a mandatory method in clinical evaluation of metaplastic and nonmetaplastic changes within HGM of the esophagus.
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Affiliation(s)
- Vasile Valeriu Lupu
- From the Pediatrics Department (VVL, AI, GP, MB), University of Medicine and Pharmacy "Gr. T. Popa"; Pathology Department (DM), "St Mary" Children's Emergency Hospital; and Psychiatry Department (AC), University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
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Dias-Pereira A, Correia T, Amaro P, Sofia C, Chaves P. Long segments of columnar-lined lower esophagus are not always metaplastic. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 107:444-8. [PMID: 26140641 DOI: 10.17235/reed.2015.3660/2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The presence of columnar epithelium in the esophagus is associated with two conditions: Barrett's esophagus and heterotopic gastric mucosa. The former results from the metaplastic replacement of the normal distal squamous esophageal lining, is associated with gastroesophageal reflux and is a pre-neoplastic condition. The second is thought as a congenital condition, resulting from the incomplete squamous epithelialization of the esophagus during embryologic development. It is found mainly in the cervical esophagus. Histologically, Barrett's esophagus is composed of an admixture of cardiac mucosa, oxintocardiac mucosa and intestinal metaplasia. Most of heterotopic gastric mucosa consists of oxynticmucosa where the mucosal glands are straight and composed of parietal and chief cells.There are few reports of heterotopic gastric mucosa in the lower esophagus, generally presenting as small islands. In the present report, a series of four cases of large lower esophageal heterotopic gastric mucosa is described. All patients were initially misdiagnosed with Barrett's esophagus and referred for surveillance. The correct diagnosis was based in endoscopic and histological features. In all, a circular tiny strip of squamous mucosa was observed at endoscopy between the lower end of the columnarlined esophagus and the esophagogastric junction, defined as the proximal end of the gastric folds. Biopsy samples taken from the columnar-lined segments of the four patients showed pure oxyntic mucosa.When columnar-lined esophagus is observed in the distal esophagus not in continuity with gastric mucosa, the diagnosis of heterotopic gastric mucosa must be thought and confirmed histologically by the presence of pure oxyntic mucosa.
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Govani SM, Metko V, Rubenstein JH. Prevalence and risk factors for heterotopic gastric mucosa of the upper esophagus among men undergoing routine screening colonoscopy. Dis Esophagus 2015; 28:442-7. [PMID: 24758607 PMCID: PMC4209009 DOI: 10.1111/dote.12221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of heterotopic gastric mucosa of the upper esophagus (inlet patch) has a wide range depending on the method and detail of examination. The inlet patch is believed to be a congenital malformation that rarely leads to symptoms. We aimed to quantify the prevalence of the inlet patch in a non-referred population and determine if there are any risk factors or associated symptoms. Men between ages 50 and 79 presenting for routine colonoscopy at two clinical sites were recruited to undergo an upper endoscopy. Endoscopists were prompted to examine for the presence of the inlet patch. Of the 822 enrolled patients, 795 had data regarding the presence of an inlet patch. Of these, 55 (6.9%) had an inlet patch identified. Education was inversely associated (odds ratio [OR] advanced degree vs. high school or less = 0.310; 95% confidence interval [CI] = 0.111, 0.869), and tobacco use was positively associated with the presence of an inlet patch (current vs. never smokers OR = 2.87; 95% CI = 1.23, 6.69; former vs. never smokers OR = 1.93; 95% CI = 0.922, 4.02). No association between the inlet patch and symptoms of heartburn, globus, or dysphagia was found. In a cross-sectional study of colon cancer screenees, inlet patches were common and were not associated with symptoms. Tobacco use appears to be associated with the presence of an inlet patch.
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Affiliation(s)
- Shail M. Govani
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Valbona Metko
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joel H. Rubenstein
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA,Center for Clinical Management Research, Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
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Tanaka M, Ushiku T, Ikemura M, Shibahara J, Seto Y, Fukayama M. Esophageal adenocarcinoma arising in cervical inlet patch with synchronous Barrett's esophagus-related dysplasia. Pathol Int 2015; 64:397-401. [PMID: 25143128 DOI: 10.1111/pin.12181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 06/10/2014] [Indexed: 01/16/2023]
Abstract
Esophageal adenocarcinomas usually develop in Barrett's esophagus, typically through the metaplasia-dysplasia-carcinoma sequence, but adenocarcinomas can occur from heterotopic gastric mucosa in cervical esophagus (inlet patch). This report describes the first case of synchronous presentation of adenocarcinoma arising from cervical inlet patch and Barrett's esophagus-related dysplasia in a 76-year-old man. Surveillance CT detected a 3-cm polypoid mass in the cervical esophagus. Endoscopic biopsies confirmed a diagnosis of adenocarcinoma of the cervical esophagus. Barrett's esophagus was present also in the lower esophagus. Histologic examination of the surgically resected specimen revealed the polypoid mass as composed of tubular adenocarcinoma, and was associated with non-neoplastic columnar mucosa representing pre-existing inlet patch. Another isolated cervical inlet patch with intestinal metaplasia was also recognized. In the lower esophagus, high-grade dysplasia was noted within the Barrett's esophagus. Immunohistochemically, the adenocarcinoma associated with inlet patch had intestinal immunophenotype (CDX2-, CD10- and MUC2-positive), whereas the Barrett's esophagus-related high-grade dysplasia showed mixed immunophenotype (MUC5AC- and MUC6-positive, with scattered MUC2-positive goblet cells). Previous studies and our findings suggest that intestinal metaplasia might predispose to the development of adenocarcinoma in the inlet patch. Therefore, endoscopists and pathologists should be aware of rare malignant transformation of inlet patches, especially those with intestinal metaplasia.
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Affiliation(s)
- Mariko Tanaka
- Department of Pathology and Diagnostic Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Fang Y, Chen L, Chen DF, Ren WY, Shen CF, Xu Y, Xia YJ, Li JW, Wang P, Zhang AR, Shao SZ, Yu XN, Peng GY, Fang DC. Prevalence, histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients. World J Gastroenterol 2014; 20:17588-17594. [PMID: 25516674 PMCID: PMC4265621 DOI: 10.3748/wjg.v20.i46.17588] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/18/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the prevalence, demographic, clinical and histopathologic features of heterotopic gastric mucosa (HGM) in Chinese patients.
METHODS: Patients referred to three endoscopy units were enrolled in this study. The macroscopic characteristics of HGM were documented. Biopsies were obtained and observed using hematoxylin and eosin staining. Helicobacter pylori colonization was examined by Whartin-Starry staining.
RESULTS: HGM was observed in 420 Chinese patients, yielding a prevalence of 0.4%. The majority of patients had a single patch (300/420; 71.4%), while the remainder had two (84/420; 20%) or multiple patches (36/420; 8.6%). The size of the patches and the distance from the patch to the frontal incisor teeth varied significantly. The large majority of HGM patches were flat (393/420; 93.6%), whereas the remaining patches were slightly elevated. The primary histological characteristic was fundic-type (216/420; 51.4%) within the HGM patch, and antral- (43/420; 10.2%) and transitional-type (65/420; 15.5%) mucosa were also observed. The prevalence of intestinal metaplasia was 3.1% (13/420) and the prevalence of dysplasia was 1.4% (6/420), indicating the necessity for endoscopic follow-up in patients with HGM. Esophageal and extraesophageal complaints were also observed in patients with HGM. Dysphagia and epigastric discomfort (odds ratios: 6.836 and 115.826, respectively; Ps < 0.05) were independent risk factors for HGM.
CONCLUSION: Clinical complaints should be considered to improve the detection rate of HMG. The prevalence of intestinal metaplasia and dysplasia also indicates a need for endoscopic follow-up.
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Heterotopic gastric mucosa of upper oesophagus: evaluation of 12 cases during gastroscopic examination. GASTROENTEROLOGY REVIEW 2014; 9:302-6. [PMID: 25396006 PMCID: PMC4223111 DOI: 10.5114/pg.2014.45490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/05/2014] [Accepted: 01/21/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Oesophageal heterotopic gastric mucosa mostly presents in the upper part of the oesophagus. It is commonly under-diagnosed because of its localisation. AIM To expose the association between heterotopic gastric mucosa and endoscopic features of the upper gastrointestinal tract. MATERIAL AND METHODS A total of 1860 upper endoscopic examinations performed between January 2012 and July 2013 were analysed retrospectively. Endoscopic features and histological examinations of 12 heterotopic gastric mucosa (HGM) of the upper oesophagus were documented and evaluated retrospectively. RESULTS There were 7 (58%) male and 5 (42%) female patients aged between 22 and 80 years with a mean age of 43.2 years. Heterotopic gastric mucosa was present in 12 (0.6%) of all patients. We were able to perform biopsy for histopathological observation on 8 (66%) of the 12 patients in which HGM was seen during endoscopy. Five (42%) patients with heterotopic gastric mucosa had oesophagitis. Los Angeles Grade A oesophagitis was found in all patients, and histologically proven Barrett's oesophagus was detected in only one patient. CONCLUSIONS When a patient has ongoing dyspeptic complaints and reflux symptoms despite the treatment, one should be careful about possible HGM during upper gastrointestinal endoscopy. The point to be taken into consideration for patients who have metaplasia or dysplasia within HGM may need to be considered for surveillance.
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Heterotopic gastric mucosa of the proximal oesophagus (inlet patch): endoscopic prevalence, histological and clinical characteristics in paediatric patients. Eur J Gastroenterol Hepatol 2014; 26:1139-45. [PMID: 25099680 DOI: 10.1097/meg.0000000000000177] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Heterotopic gastric mucosa is found in the proximal oesophagus, just below the upper oesophageal sphincter, and is encountered when the oesophagus is examined carefully during endoscopy. AIMS In this study on paediatric patients, we aimed to determine the endoscopic prevalence of heterotopic gastric mucosa of the proximal oesophagus (HGMPO), to identify its macroscopic and histological characteristics and to evaluate its clinical features. PATIENTS AND METHODS A total of 1399 patients were examined. Ages, sex, clinical and endoscopic findings of all patients were recorded. Patients with HGMPO were classified in accordance with a clinicopathological classification and information on the treatment and evolution was also recorded. RESULTS Of the 1399 patients, 20 (11 male) were found to have HGMPO. The prevalence of HGMPO was determined to be 1.4%. In five patients, the upper oesophageal and laryngopharyngeal symptoms were remarkable. The clinicopathological classification showed that 15 patients were HGMPO type 1 (asymptomatic) and five were type 2 (symptomatic without morphologic changes). There was no significant association of any other endoscopic finding with the presence of an HGMPO. Proton pump inhibitors treatment was initiated in 16 patients, including those with HGMPO type 2. In one type 2 patient who showed no improvement during medical treatment, endoscopic treatment was indicated (argon plasma ablation). In patients with symptoms attributable to the presence of the inlet patch, the proposed treatment resolved clinical symptoms. CONCLUSION The presence of HGMPO is not an infrequent finding in thorough endoscopies. Although HGMPO does not usually have a symptomatic progression, it can sometimes lead to supraoesophageal symptoms; thus, treatment should be considered.
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SAHIN G, ADAS G, KOC B, AKCAKAYA A, DOGAN Y, Goksel S, Yalcin O. Is cervical inlet patch important clinical problem? INTERNATIONAL JOURNAL OF BIOMEDICAL SCIENCE : IJBS 2014; 10:129-35. [PMID: 25018682 PMCID: PMC4092081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 04/10/2014] [Indexed: 11/02/2022]
Abstract
AIM In this study we aim to determine the frequency of Inlet Patch (IP) and its association to clinical symptoms and draw attention to be aware of this heterotopic gastric mucosa. METHODS This study was a prospective case series that IP was detected in the upper gastrointestinal endoscopy. Patients with laringopharyngeal reflux symptoms underwent endoscopy between March 2009 and July 2012 in two different institutions. All the biopsies were obtained from if there is the IP lesion and antral or/and gastric mucosa. The data was prospectively evaluated. The prevalence was compared with those of patients that did not determine IP in the study period. RESULTS 3907 upper gastrointestinal system endoscopy was performed while 123 patients consist of 51 male and 72 female was determined as IP. The prevalence of IP in patiens who underwent upper gastrointestinal endoscopy was 3.14% in our study. The majority of symptoms of those who had IP were laringopharyngeal reflux symptoms. Heterotopic gastric mucosa was fixed in 114 cases while 28 chronic inflammation, 9 esophagitis, 5 intestinal metaplasia, 4 glicogenic acanthosis were obtained as additional findings in pathological examinations. CONCLUSION Heterotopic gastric mucosa in the proximal esophagus is a frequent finding if the endoscopist is aware of this entity. The importance of IP is the increasing number of cases of neoplastic transformation. Symptomatic patients should be treated and should be considered of the complications of heterotopic gastric mucosa.
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Affiliation(s)
- Gurol SAHIN
- Ethica Hospital, Department of Surgery/Istanbul, Turkey
| | - Gokhan ADAS
- Bakırkoy Sadi Konuk Training and Research Hospital, Department of Surgery/Istanbul, Turkey
| | - Bora KOC
- Bakırkoy Sadi Konuk Training and Research Hospital, Department of Surgery/Istanbul, Turkey
| | - Adem AKCAKAYA
- Bezmialem Vakif University, Department of Surgery/Istanbul, Turkey
| | - Yasar DOGAN
- Bakırkoy Sadi Konuk Training and Research Hospital, Department of Surgery/Istanbul, Turkey
| | - Suha Goksel
- University of Acıbadem, Medical School, Department of Pathology/Istanbul, Turkey
| | - Ozben Yalcin
- University of Acıbadem, Medical School, Department of Pathology/Istanbul, Turkey
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Tsai TH, Fujimoto JG, Mashimo H. Endoscopic Optical Coherence Tomography for Clinical Gastroenterology. Diagnostics (Basel) 2014; 4:57-93. [PMID: 26852678 PMCID: PMC4665545 DOI: 10.3390/diagnostics4020057] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 12/12/2022] Open
Abstract
Optical coherence tomography (OCT) is a real-time optical imaging technique that is similar in principle to ultrasonography, but employs light instead of sound waves and allows depth-resolved images with near-microscopic resolution. Endoscopic OCT allows the evaluation of broad-field and subsurface areas and can be used ancillary to standard endoscopy, narrow band imaging, chromoendoscopy, magnification endoscopy, and confocal endomicroscopy. This review article will provide an overview of the clinical utility of endoscopic OCT in the gastrointestinal tract and of recent achievements using state-of-the-art endoscopic 3D-OCT imaging systems.
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Affiliation(s)
- Tsung-Han Tsai
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Hiroshi Mashimo
- Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA 02115, USA.
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Yu L, Yang Y, Cui L, Peng L, Sun G. Heterotopic gastric mucosa of the gastrointestinal tract: prevalence, histological features, and clinical characteristics. Scand J Gastroenterol 2014; 49:138-44. [PMID: 24279774 DOI: 10.3109/00365521.2013.860558] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heterotopic gastric mucosa (HGM) may be located at sites throughout the gastrointestinal (GI) tract. Clinical characteristics of HGM, role of Helicobacter pylori infection, natural history, and relationship to neoplastic transformation have not sufficiently been explored. AIM To retrospectively study the prevalence, histological features, and clinical characteristics of HGM among Chinese patients who underwent upper GI endoscopy. METHODS Endoscopic, histological, and clinical records of patients, who underwent upper GI endoscopy (n = 6802) and colonoscopy (n = 3504), respectively, between May 2011 and May 2012, were collected and retrospectively analyzed. A total of 6716 sex- and age-matched patients without HGM were enrolled as controls. RESULTS HGM was diagnosed in 86 cases (51 esophageal, 0.75%; 35 duodenal, 0.51%). Male:female ratio was 1.4:1 (30/21) for esophageal HGM, 1.7:1 (22/13) for duodenal HGM, and 1.1:1 (3557/3159) for controls. Two histopathological types of HGM were identified: foveolar epithelium alone and foveoloar epithelium together with gastric glands. Helicobacter pylori were present in 19.6% of cases with esophageal HGM and 20.0% of cases with duodenal HGM. Esophageal HGM was significantly associated with dysphagia and globus; duodenal HGM was not significantly associated with GI symptoms. Intestinal metaplasia was present in two and three patients in both groups, respectively, with no dysplasia or carcinoma. CONCLUSION HGM was present in fewer patients undergoing upper GI endoscopy, and it was more often present in men. A careful endoscopic examination is required to diagnose HGM, and it should be supported with a biopsy when indicated.
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Affiliation(s)
- Lan Yu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital , Beijing , China
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Cheng CL, Lin CH, Liu NJ, Tang JH, Kuo YL, Tsui YN. Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images. World J Gastroenterol 2014; 20:242-249. [PMID: 24415878 PMCID: PMC3886015 DOI: 10.3748/wjg.v20.i1.242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/23/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
METHODS: A prospective study with a total of 760 patients receiving a CI examination (mean age 51.6 years; 47.8% male) and 760 patients undergoing NBI examination (mean age 51.2 years; 45.9% male). The size of HGM was classified as small (1-5 mm), medium (6-10 mm), or large (> 1 cm). A standardized questionnaire was used to obtain demographic characteristics, social habits, and symptoms likely to be related to cervical esophageal HGM, including throat symptoms (globus sensation, hoarseness, sore throat, and cough) and upper esophageal symptoms (dysphagia and odynophagia) at least 3 mo in duration. The clinicopathological classification of cervical esophageal HGM was performed using the proposal by von Rahden et al.
RESULTS: Cervical esophageal HGM was found in 36 of 760 (4.7%) and 63 of 760 (8.3%) patients in the CI and NBI groups, respectively (P = 0.007). The NBI mode discovered significantly more small-sized HGM than CI (55% vs 17%; P < 0.0001). For the 99 patients with cervical esophageal HGM, biopsies were performed in 56 patients; 37 (66%) had fundic-type gastric mucosa, and 19 had antral-type mucosa. For the clinicopathological classification, 77 patients (78%) were classified as HGM I (asymptomatic carriers); 21 as HGM II (symptomatic without morphologic changes); and one as HGM III (symptomatic with morphologic change). No intraepithelial neoplasia or adenocarcinoma was found.
CONCLUSION: NBI endoscopy detects more cervical esophageal HGM than CI does. Fundic-type gastric mucosa constitutes the most common histology. One-fifth of patients have throat or dysphagic symptoms.
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Bajbouj M, Meining A, Schmid RM. Endoscopic diagnosis and treatment of inlet patch: Justification, techniques, and results. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Clinical evaluation of twenty cases of heterotopic gastric mucosa of upper esophagus during five-year observation, using gastroscopy in combination with histopathological and microbiological analysis of biopsies. Contemp Oncol (Pozn) 2013; 17:171-5. [PMID: 23788986 PMCID: PMC3685377 DOI: 10.5114/wo.2013.34376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/29/2012] [Accepted: 02/14/2013] [Indexed: 12/11/2022] Open
Abstract
Aim of the study Heterotopic gastric mucosa of the upper esophagus (HGMUE) may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. Furthermore, HGMUE may be the origin of malignant progression to cervical esophageal carcinoma. Material and methods In this work, 20 patients with diagnosed heterotopic gastric mucosa of the upper esophagus (HGMUE) were subjected to 5-year follow-up to determine the extent and structure of histopathological changes within HGMUEs, as well as HGMUE dysplasia and metaplasia, and risk of their malignant transformation. As a diagnostic tool to describe localization, form, size and surface feature of HGMUEs, endoscopy was used. At the same time, the biopsies were collected for histopathological and microbiological analysis. Results In examined patients, HGMUEs were associated with inflammation, chronic gastritis, hiatus hernia, duodenal bulb erosion and ulcer and infection of H. pylori. Intestinal metaplasia and low grade dysplasia were also indicated. During 5 years of observation, both the clinical and histopathological image of diagnosed HGMUEs was stable. The patients with detected presence of H. pylori were treated with triple or quadruple therapy. These results show that HGMUEs may be associated with severe complications in the gastrointestinal tract, such as infection by H. pylori, hiatus hernia or duodenal ulcer. Although dysplasias and metaplasias found in diagnosed HGMUEs were not very numerous and relatively stable both clinically and histopathologically, at the present stage of the study we cannot exclude the possibility of HGMUE malignant transformation.
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Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol 2013; 19:331-8. [PMID: 23372354 PMCID: PMC3554816 DOI: 10.3748/wjg.v19.i3.331] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/30/2012] [Accepted: 08/16/2012] [Indexed: 02/06/2023] Open
Abstract
Heterotopic gastric mucosa of the proximal esophagus (HGMPE), also referred to as “inlet patch” or “cervical inlet patch”, is a salmon colored patch that is usually located just distal to the upper esophageal sphincter. HGMPE is uncommon with endoscopic studies reporting a prevalence ranging from less than one percent to 18%. Most HGMPE are asymptomatic and are detected incidentally during endoscopy for evaluations of other gastrointestinal complaints. Most consider HGMPE as clinically irrelevant entity. The clinical significance of HGMPE is mainly acid related or neoplastic transformation. The reported prevalence of laryngopharyngeal reflux symptoms varies from less than 20% to as high as 73.1%. However, most of these symptoms are mild. Clinically significant acid related complications such as bleeding, ulcerations, structure and fistulization have been reported. Although rare, dysplastic changes and malignancies in association with HGMPE have also been reported. Associations with Barrett’s esophagus have also been reported but the findings so far have been conflicting. There are still many areas that are unknown or not well understood and these include the natural history of HGMPE, risk factors for complications, role of Helicobacter pylori infection and factors associated with malignant transformations. Follow-up may need to be considered for patients with complications of HGMPE and surveillance if biopsies show intestinal metaplasia or dysplastic changes. Despite the overall low incidence of clinically relevant manifestations reported in the literature, HGMPE is a clinically significant entity but further researches are required to better understand its clinical significance.
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Terada T. A clinicopathologic study of esophageal 860 benign and malignant lesions in 910 cases of consecutive esophageal biopsies. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:191-198. [PMID: 23330004 PMCID: PMC3544238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 11/24/2012] [Indexed: 06/01/2023]
Abstract
The author reviewed 910 cases of consecutive esophageal biopsies in the last 15 year in the pathology laboratory of our hospital. There were 693 normal mucosa and benign lesions (76.2%) and 217 malignant lesions (23.8%). No significant changes were recognized in the esophagus in 50 biopsies (5.5%). In benign lesions, the number and frequency (percentages) were as follows: 263 chronic esophagitis (28.9%), 98 heterotopic gastric mucosa (10.8%), 3 heterotopic colonic mucosa (0.3%), 71 glycogenic acanthosis (7.8%), 68 candidiasis (7.5%), 35 benign ulcer (3.8%), 41 squamous papilloma (4.5%), 4 granular cell tumor (0.4%), 1 tubular adenoma (0.1%), 2 cytomegalovirus esophagitis (0.2%), 3 leiomyoma (0.3%), 17 basal cell hyperplasia (1.9%), and 37 Barrett's epithelium (4%). In malignant lesions, the number and frequency (percentages) were as follows: 53 mild dysplasia (5.8%), 29 moderate dysplasia (3.2%), 31 severe dysplasia (3.4%), 13 carcinoma in situ (1.4%), 68 squamous cell carcinoma (7.5%), 7 primary adenocarcinoma (0.8%), 1 primary signet ring cell carcinoma (0.1%), 4 primary small cell carcinoma (0.4%), 2 primary amelanotic malignant melanoma (0.2%), 1 primary undifferentiated sarcoma (0.1%), 7 gastric cancer invasion (0.8%), and 1 primary adenoid cystic carcinoma (0.1%). In this article, the clinicopathologic features of these esophageal lesions were described.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital Shizuoka, Japan.
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Aggressive adenocarcinoma of the cervical esophagus: importance of a multidisciplinary approach. Case Rep Gastrointest Med 2012; 2012:826246. [PMID: 23304576 PMCID: PMC3529900 DOI: 10.1155/2012/826246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/23/2012] [Indexed: 11/18/2022] Open
Abstract
Adenocarcinoma of the cervical esophagus is a rare tumor, in comparison to adenocarcinoma of the distal esophagus which is on the rise and is often associated with Barrett's esophagus. We present a case of aggressive cervical esophageal adenocarcinoma in a 46-year-old female with no endoscopic or histopathologic evidence of Barrett's esophagus. We discuss the possible etiology of this tumor and review the treatment options, highlighting the importance of a multidisciplinary approach to the management of this rare disease.
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Rosztóczy A, Izbéki F, Németh IB, Dulic S, Vadászi K, Róka R, Gecse K, Gyökeres T, Lázár G, Tiszlavicz L, Wittmann T. Detailed esophageal function and morphological analysis shows high prevalence of gastroesophageal reflux disease and Barrett's esophagus in patients with cervical inlet patch. Dis Esophagus 2012; 25:498-504. [PMID: 22107367 DOI: 10.1111/j.1442-2050.2011.01281.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the pathogenesis of cervical inlet patch (CIP) is not fully understood, most authors consider it as a congenital abnormality, whereas others surmise it to be related to gastroesophageal reflux disease (GERD). We aimed to evaluate esophageal function and the prevalence of GERD and Barrett's esophagus in patients with CIP. GERD is defined by the presence of erosive esophagitis or an abnormal pH monitoring. Seventy-one consecutive patients with endoscopic and histological evidence of CIP were prospectively evaluated. Esophageal symptom analysis, 24-hour simultaneous biliary reflux and double-channel pH-monitoring, and esophageal manometry were carried out in 65/71 (92%) patients and in 25 matched controls. Six patients were not suitable for testing and were, therefore, excluded. The histological evaluation of the heterotopic islands showed cardia and/or oxyntic mucosa in 64/65 (98%) patients and specialized intestinal metaplasia (SIM) in one patient (2%). The cardia and/or oxyntic mucosa was accompanied by focally appearing pancreatic acinar metaplasia and pancreatic ductal metaplasia in 7/64 (11%) and in 1/64 (2%), superficial mucous glands in 6/64 (9%), and SIM in 2/64 (3%) cases. In total, SIM was present in three patients (5%), and one of them had low-grade dysplasia. At the gastroesophageal junction, 28 (43%) patients had columnar metaplasia, including nine (14%) patients with SIM. Erosive esophagitis was present in 37 (57%) cases. Thirty-two patients (49%) had abnormal acid reflux in the distal and 25 (38%) in the proximal esophagus. Abnormal biliary reflux was present in 25 (38%) cases. On the basis of endoscopic and pH studies, GERD was established in 44/65 (68%) patients. Typical reflux symptoms were common (33/65, 51%). The combined 24-hour biliary and double-channel pH-monitoring detected significantly more significant acidic reflux at both measurement points and significantly longer bile exposure time in the distal esophagus in patients with CIP. Acid secretion in the CIP was detected in three (5%) cases. Esophageal manometry revealed decreased LES pressure and prolonged relaxation with decreased peristaltic wave amplitude, and an increased number of simultaneous contractions in the esophageal body. The detailed evaluation of the esophageal morphology and function in subjects with CIP showed a high prevalence of GERD and Barrett's esophagus. Further studies are needed to evaluate whether combined acidic and biliary reflux is able to promote similar histomorphological changes in the CIP, as it is shown distally in patients with Barrett's esophagus.
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Affiliation(s)
- A Rosztóczy
- First Department of Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged State Health Centre, Budapest, Hungary.
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Zhou C, Kirtane T, Tsai TH, Lee HC, Adler DC, Schmitt JM, Huang Q, Fujimoto JG, Mashimo H. Cervical inlet patch-optical coherence tomography imaging and clinical significance. World J Gastroenterol 2012; 18:2502-10. [PMID: 22654447 PMCID: PMC3360448 DOI: 10.3748/wjg.v18.i20.2502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 01/09/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To demonstrate the feasibility of optical coherence tomography (OCT) imaging in differentiating cervical inlet patch (CIP) from normal esophagus, Barrett’s esophagus (BE), normal stomach and duodenum.
METHODS: This study was conducted at the Veterans Affairs Boston Healthcare System (VABHS). Patients undergoing standard esophagogastroduodenoscopy at VABHS, including one patient with CIP, one representative patient with BE and three representative normal subjects were included. White light video endoscopy was performed and endoscopic 3D-OCT images were obtained in each patient using a prototype OCT system. The OCT imaging probe passes through the working channel of the endoscope to enable simultaneous video endoscopy and 3D-OCT examination of the human gastrointestinal (GI) tract. Standard hematoxylin and eosin (H and E) histology was performed on biopsy or endoscopic mucosal resection specimens in order to compare and validate the 3D-OCT data.
RESULTS: CIP was observed from a 68-year old male with gastroesophageal reflux disease. The CIP region appeared as a pink circular lesion in the upper esophagus under white light endoscopy. OCT imaging over the CIP region showed columnar epithelium structure, which clearly contrasted the squamous epithelium structure from adjacent normal esophagus. 3D-OCT images obtained from other representative patients demonstrated distinctive patterns of the normal esophagus, BE, normal stomach, and normal duodenum bulb. Microstructures, such as squamous epithelium, lamina propria, muscularis mucosa, muscularis propria, esophageal glands, Barrett’s glands, gastric mucosa, gastric glands, and intestinal mucosal villi were clearly observed with OCT and matched with H and E histology. These results demonstrated the feasibility of using OCT to evaluate GI tissue morphology in situ and in real-time.
CONCLUSION: We demonstrate in situ evaluation of CIP microstructures using 3D-OCT, which may be a useful tool for future diagnosis and follow-up of patients with CIP.
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Neumann WL, Luján GM, Genta RM. Gastric heterotopia in the proximal oesophagus ("inlet patch"): Association with adenocarcinomas arising in Barrett mucosa. Dig Liver Dis 2012; 44:292-6. [PMID: 22222950 DOI: 10.1016/j.dld.2011.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 10/27/2011] [Accepted: 11/11/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of inlet patches and their association with other conditions of the gastrointestinal tract have been studied prospectively in tertiary care facilities; little is known about practice patterns in private outpatient clinics and endoscopy centres. AIMS To assess prevalence, demographic determinants, and associated clinicopathologic features of inlet patches in patients who had oesophagogastroduodenoscopy in outpatient settings throughout the United States. METHODS Retrospective analysis of the clinicopathologic records of 487,229 unique patients who had oesophagogastroduodenoscopy with biopsies between January 2008 and December 2010. RESULTS There were 870 patients with inlet patches with a prevalence of 0.18%. Significant associations included male gender (OR 1.68), dysphagia (OR 1.34), upper respiratory complaints (OR 2.81), globus (OR 5.39) Barrett oesophagus (OR 1.55), and adenocarcinomas arising in Barrett mucosa (OR 5.64). CONCLUSIONS The prevalence of inlet patches in a tertiary care setting (0.18%) was considerably lower than reported in prospective studies (3.7% on average). Inlet patches were significantly associated with male gender, dysphagia, upper respiratory complaints, globus, Barrett mucosa, and adenocarcinomas arising in Barrett oesophagus. Further studies will be needed to determine if patients with inlet patches and Barrett mucosa benefit from increased surveillance.
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Katsanos KH, Sigounas DE, Christodoulou DK, Tsianos EV. Upper esophageal ring due to gastric heterotopia. Ann Gastroenterol 2012; 25:163. [PMID: 24714227 PMCID: PMC3959403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/02/2012] [Indexed: 11/23/2022] Open
Affiliation(s)
- Konstantinos H. Katsanos
- 1st Department of Internal Medicine & Hepato-Gastroenterology Unit, University Hospital of Ioannina, Greece
| | - Dimitrios E. Sigounas
- 1st Department of Internal Medicine & Hepato-Gastroenterology Unit, University Hospital of Ioannina, Greece
| | - Dimitrios K. Christodoulou
- 1st Department of Internal Medicine & Hepato-Gastroenterology Unit, University Hospital of Ioannina, Greece
| | - Epameinondas V. Tsianos
- 1st Department of Internal Medicine & Hepato-Gastroenterology Unit, University Hospital of Ioannina, Greece,
Correspondence to: Prof. Epameinondas V. Tsianos, MD, PhD, AGAF, Professor of Internal Medicine, Department of Internal Medicine, Medical School, University of Ioannina, Leoforos Panepistimiou, 45 110 Ioannina, Greece Tel: +30 26510 07501, Fax: +30 26510 07016, e-mail:
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Park S, Jai Chun H, Keum B, Uhm CS, Baek SK, Jung KY, Joon Lee S. In response to An electron microscopic study-correlation of gastroesophageal reflux disease and laryngopharyngeal reflux. Laryngoscope 2011. [DOI: 10.1002/lary.21834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Double primary cancer of the esophagus consisting of ectopic gastric mucosa-derived adenocarcinoma and squamous cell carcinoma: a first case report. Esophagus 2011. [DOI: 10.1007/s10388-011-0296-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Abstract
OBJECTIVES An inlet patch (IP) is defined as heterotopic gastric mucosa located in the proximal esophagus. Little information is available in children. The aim of this retrospective study was to assess clinical significance, endoscopic and histological characteristics, and natural history of IP in children. PATIENTS AND METHODS This retrospective multicenter study included all of the cases of IP recorded in 7 tertiary French pediatric gastrointestinal centers. Information about demographics, clinical symptoms, endoscopic characteristics, histology, treatment, and evolution was collected. RESULTS Fifteen children were included (8 boys, 7 girls). The median age at diagnosis was 9.5 years (range 3.3-15 years). Five children had esophageal atresia and 9 had gastroesophageal reflux. Only 1 child was asymptomatic. Digestive symptoms (dysphagia, food impaction) were noted in 14 patients and respiratory or ear, nose, and throat symptoms in 6. At endoscopy, IP was characterized by a small, round salmon-pink lesion of the proximal esophagus. Helicobacter pylori was found in 2 patients. Proton pump inhibitor treatment was initiated in 14 children for a mean duration of 4.7 months (range 1-12 months). Two patients were lost to follow-up. Clinical symptoms disappeared in 5 patients and decreased in 3 others. One case of hematemesis was noted after a mean follow-up of 9 months. Recurrent symptoms were noted in 2 patients after treatment discontinuation. CONCLUSIONS IP is an uncommon but almost certainly underrecognized lesion in children, and may be the cause of digestive and respiratory symptoms in some children.
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Terada T. Heterotopic gastric mucosa of the gastrointestinal tract: A histopathologic study of 158 cases. Pathol Res Pract 2011; 207:148-50. [DOI: 10.1016/j.prp.2010.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 09/04/2010] [Accepted: 12/15/2010] [Indexed: 12/17/2022]
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Weickert U, Wolf A, Schröder C, Autschbach F, Vollmer H. Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients. Dis Esophagus 2011; 24:63-8. [PMID: 20626446 DOI: 10.1111/j.1442-2050.2010.01091.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The frequency and clinical significance of heterotopic gastric mucosa in the upper esophagus is not sufficiently known. Heartburn or dysphagia could result from mucin and/or acid production in this area. We undertook a prospective study in 300 patients with special attention of the endoscopist to this area. Moreover, clinical symptoms were determined by questionnaire before performing endoscopy. A total of 33/300 (11%) of patients had at least one histologically proven gastric inlet patch without gender or age preference. In 20/33 (61%) cases, the heterotopic gastric mucosa was classified as mixed type, in 8/33 (24%) as oxyntic, and in 5/33 (15%) as mucoid. Helicobacter pylori was present in none of the cases. There was no significant association to the presence of a hiatal hernia, reflux esophagitis, Barrett's esophagus, or gastric/duodenal ulcer. Moreover, there was no association to the reported grade of heartburn in the upper or lower part of the esophagus, recurrent hoarseness, or dysphagia. When thoroughly performed, heterotopic gastric mucosa is a quite frequent finding in endoscopy of the upper gastrointestinal tract. The presence of this gastric mucosa in the upper third of the esophagus seems to be rarely the cause of clinical symptoms and little prone to complications.
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Affiliation(s)
- U Weickert
- Department of Medicine II, Klinikum Heilbronn, Academic Hospital of the University of Heidelberg, Heilbronn, Germany.
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