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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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Dziadkowiec KN, Sánchez-Luna SA, Stawinski P, Proenza J. Adenocarcinoma Arising From a Cervical Esophageal Inlet Patch: The Malignant Potential of a Small Lesion. Cureus 2020; 12:e9284. [PMID: 32832282 PMCID: PMC7437138 DOI: 10.7759/cureus.9284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/19/2020] [Indexed: 11/21/2022] Open
Abstract
Inlet patches (IP) are heterotopic lesions consisting of gastric mucosa. Commonly located in the cervical esophagus, it is believed that they are remnants of fetal columnar epithelium arising from incomplete replacement during embryogenesis. A rare complication of IP is the development of proximal esophageal adenocarcinoma. We report a case of a 59-year-old male with intractable cough and dysphagia that was found to have a malignant transformation of an IP.
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Affiliation(s)
| | - Sergio A Sánchez-Luna
- Center for Advanced Therapeutic Endoscopy/Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network/Allegheny Center for Digestive Health, Pittsburgh, USA
| | - Peter Stawinski
- Internal Medicine, University of Miami, John F. Kennedy Regional Campus, Atlantis, USA
| | - Jose Proenza
- Gastroenterology, West Palm Beach Veterans Affairs Medical Center, West Palm Beach, USA
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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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Di Nardo G, Cremon C, Bertelli L, Oliva S, De Giorgio R, Pagano N. Esophageal Inlet Patch: An Under-Recognized Cause of Symptoms in Children. J Pediatr 2016; 176:99-104.e1. [PMID: 27318379 DOI: 10.1016/j.jpeds.2016.05.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/13/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the incidence of inlet patch (IP) and to assess the clinical and pathological features, role of the diagnostic workup in treatment decision making, efficacy of medical and endoscopic therapy, and natural history in a pediatric population. STUDY DESIGN Consecutive patients aged <18 years (n = 1000) undergoing esophagogastroduodenoscopy were enrolled prospectively. Biopsy specimens were obtained from IPs and the proximal and distal esophagus, stomach, and duodenum. Multichannel intraluminal impedance and pH monitoring (MII-pH) was performed in all symptomatic patients. Symptomatic patients were treated with proton pump inhibitors for 8 weeks, and IP ablation by argon plasma coagulation (APC) was performed in unresponsive patients. RESULTS The endoscopic incidence of IP was 6.3%, with a cumulative missing rate of 5.8%. Thirty-five of the 63 patients (56%) were asymptomatic, 11 (17%) had symptoms clearly related to the underlying digestive disorder, and 17 (27%) had chronic IP-related symptoms. MII-pH was positive in 10 of the 28 symptomatic patients. All 17 patients with IP-related symptoms were unresponsive to proton pump inhibitors and were treated with APC, and all had achieved complete remission by the 3-year follow-up. Patients with underlying disorders were successfully treated with medical therapy, and asymptomatic patients remained symptom-free, with no endoscopic or histological changes seen at the 3-year follow-up. CONCLUSION IP is an under-recognized cause of symptoms in children with unexplained esophageal and respiratory symptoms. MII-pH and bioptic sampling are needed to exclude entities mimicking IP symptoms and to direct therapy. APC is safe and effective for treating IP-related symptoms.
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Affiliation(s)
- Giovanni Di Nardo
- Pediatric Unit, Orvieto Hospital, Orvieto, Italy; Pediatric Gastroenterology Unit, International Hospital Salvator Mundi, Rome, Italy.
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Bertelli
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Roberto De Giorgio
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Nico Pagano
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
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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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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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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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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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Heterotopic gastric mucosal patch in patients with reflux laryngitis: an entity of clinical interest? Surg Laparosc Endosc Percutan Tech 2011; 19:361-3. [PMID: 19851260 DOI: 10.1097/sle.0b013e3181bae1be] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Heterotopic gastric mucosal patch (HGMP) in the upper esophagus has been suggested to play a role in the pathogenesis of laryngopharyngeal reflux. The aim of this study was to evaluate the prevalence and possible clinical significance of HGMPs in patients who underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease-induced reflux laryngitis.Forty consecutive patients with pH-proven reflux laryngitis referred to surgery by a specialist in otorhinolaryngology underwent laparoscopic Nissen fundoplication between 1998 and 2002. Twenty-seven (67.5%) of these patients underwent a postoperative upper gastrointestinal endoscopy paying special attention for detecting possible HGMPs in the proximal esophagus. When HGMP was found, biopsies were taken for histologic confirmation. A small histologically confirmed HGMP was detected in 1 out of 27 patients (3.7%). The prevalence of HGMPs in the upper esophagus in this specific patient group operated on for gastroesophageal reflux disease-induced reflux laryngitis equals the reported general prevalence rates of HGMPs detected in patients referred for upper gastrointestinal endoscopy as a part of gastrointestinal tract evaluation. The role of at least small HGMPs in the proximal esophagus in the pathogenesis of laryngopharyngeal reflux is clinically insignificant.
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Katsanos KH, Christodoulou DK, Kamina S, Maria K, Lambri E, Theodorou S, Tsampoulas K, Vasiliki M, Tsianos EV. Diagnosis and endoscopic treatment of esophago-bronchial fistula due to gastric heterotopy. World J Gastrointest Endosc 2010; 2:138-42. [PMID: 21160729 PMCID: PMC2999170 DOI: 10.4253/wjge.v2.i4.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 03/13/2010] [Accepted: 03/20/2010] [Indexed: 02/05/2023] Open
Abstract
Heterotopic gastric mucosa patches are congenital gastrointestinal abnormalities and have been reported to occur anywhere along the gastrointestinal tract from mouth to anus. Complications of heterotopic gastric mucosa include dysphagia, upper gastrointestinal bleeding, upper esophageal ring stricture, adenocarcinoma and fistula formation. In this case report we describe the diagnosis and treatment of the first case of esophago-bronchial fistula due to heterotopic gastric mucosa in mid esophagus. A 40-year old former professional soccer player was referred to our department for treatment of an esophago-bronchial fistula. Microscopic examination of the biopsies taken from the esophageal fistula revealed the presence of gastric heterotopic mucosa. We decided to do a non-surgical therapeutic endoscopic procedure. A sclerotherapy catheter was inserted through which 1 mL of ready to use synthetic surgical glue was applied in the fistula and it closed the fistula opening with excellent results.
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Affiliation(s)
- Konstantinos H Katsanos
- Konstantinos H Katsanos, Dimitrios K Christodoulou, Kosmidou Maria, Epameinondas V Tsianos, 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital of Ioannina, Ioannina 45110, Greece
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Korkut E, Bektaş M, Alkan M, Ustün Y, Meco C, Ozden A, Soykan I. Esophageal motility and 24-h pH profiles of patients with heterotopic gastric mucosa in the cervical esophagus. Eur J Intern Med 2010; 21:21-4. [PMID: 20122608 DOI: 10.1016/j.ejim.2009.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/19/2009] [Accepted: 10/22/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Heterotopic gastric mucosa occurs as a flat island of red mucosa in the proximal third of the esophagus where it gives rise to the cervical inlet patch. The aims of this study were to investigate the esophageal motility pattern and 24-h pH profiles of patients with cervical inlet patch. METHODS Thirty patients (16 women, mean age: 44.9 years, range: 23-72) diagnosed as having heterotopic gastric mucosa in the cervical esophagus with upper gastrointestinal symptoms had undergone esophageal motility testing and 24-h pH monitorisation with a double-channel pH probe. RESULTS Manometric investigation was abnormal in 7 patients (non-specific esophageal motor disorder in 4 patients, esophageal hypomotility in 1 patient, and hypotensive LES in 2 patients). Pathological acid reflux (pH<4) was found in 9 (30%) of 30 heterotopic gastric mucosa patients during pH monitorisation from the distal probe. Pathological acid reflux in the proximal esophagus (percentage of total time of pH<4) was seen in four of these nine patients. Only four of the 30 patients (13.3%) presented with "acid independent episodes" during the 24-h esophageal pH monitorisation. CONCLUSION Manometric investigation and 24-h pH monitorisation revealed that some of the patients with HGM have signs of esophageal motor dysfunction and "acid independent episodes" from the patches. These abnormalities may be responsible for some of the symptoms of HGM patients.
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Affiliation(s)
- Esin Korkut
- Ankara University Medical School, Ibni Sina Hospital, Department of Gastroenterology, Ankara, Turkey
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Martins FP, Artigiani Neto R, Oshima CT, Costa PPD, N M F, Ferrari AP. Over-expression of cyclooxygenase-2 in endoscopic biopsies of ectopic gastric mucosa. Braz J Med Biol Res 2008; 40:1447-54. [PMID: 17934641 DOI: 10.1590/s0100-879x2007001100005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 07/18/2007] [Indexed: 01/01/2023] Open
Abstract
Ectopic gastric mucosa (EGM) is considered to be a congenital condition. Rare cases of adenocarcinoma have been described. There are no data justifying regular biopsies or follow-up. Cyclooxygenase-2 (COX-2) is a protein involved in gastrointestinal tumor development by inhibiting apoptosis and regulating angiogenesis. The aim of this prospective study was to evaluate COX-2 expression in EGM and compare it with normal tissue and Barrett's esophagus. We evaluated 1327 patients. Biopsies were taken from the inlet patch for histological evaluation and from the gastric antrum to assess Helicobacter pylori infection. Biopsies taken from normal esophageal, gastric antrum and body mucosa and Barrett's esophagus were retrieved from a tissue bank. EGM biopsies were evaluated with respect to type of epithelium, presence of H. pylori, and inflammation. COX-2 was detected by immunohistochemistry using the avidin-biotin complex. EGM islets were found in 14 patients (1.1%). Histological examination revealed fundic type epithelium in 58.3% of cases, H. pylori was present in 50% and chronic inflammation in 66.7%. Expression of COX-2 was negative in normal distal esophagus, normal gastric antrum and normal gastric body specimens (10 each). In contrast, EGM presented over-expression of COX-2 in 41.7% of cases and Barrett's esophagus in 90% of cases (P = 0.04 and 0.03, respectively). COX-2 immunoexpression in EGM was not related to gender, age, epithelium type, presence of inflammation or intestinal metaplasia, H. pylori infection, or any endoscopic finding. Our results demonstrate up-regulation of COX-2 in EGM, suggesting a possible malignant potential of this so-called harmless mucosa.
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Affiliation(s)
- F P Martins
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São PauloSão Paulo, SP, Brasil.
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Baudet JS, Alarcón-Fernández O, Sánchez del Río A. [Heterotopic gastric mucosa in the upper esophagus. An unknown cause of dysphagia]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:74-7. [PMID: 17335714 DOI: 10.1157/13099268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Heterotopic gastric mucosa in the proximal third of the esophagus is an embryological lesion that has been described in between 1.1% and 10% of gastroscopies. Although most of these lesions are asymptomatic, they can sometimes be accompanied by upper esophageal symptoms due to acid secretion. We present a case of heterotopic gastric mucosa in the proximal third of the esophagus with dysphagia. pH-metry demonstrated acid secretion by these lesions, which was resolved by treatment with proton pump inhibitors.
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Affiliation(s)
- Juan Salvador Baudet
- Servicio de Aparato Digestivo, Red Hospiten Tenerife, Santa Cruz de Tenerife, Spain.
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Baudet JS, Alarcón-Fernández O, Sánchez Del Río A, Aguirre-Jaime A, León-Gómez N. Heterotopic gastric mucosa: a significant clinical entity. Scand J Gastroenterol 2006; 41:1398-404. [PMID: 17101570 DOI: 10.1080/00365520600763094] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Despite the apparent lack of clinical interest in the inlet patches of heterotopic gastric mucosa (HGM) in the upper esophagus, the literature contains reports of complications associated with HGM. The aim of this study was to determine the prevalence and clinical importance of HGM in patients referred for upper gastrointestinal endoscopy (UGE). MATERIAL AND METHODS A total of 1033 consecutive outpatients referred for UGE were prospectively evaluated. Clinical, endoscopic and histologic findings were analyzed and 24-h double-channel pH-metry was performed on 20 patients with HGM. RESULTS Fifty-three patients (5.1%) had HGM lesions. Dysphagia was significantly more frequent in HGM patients (21% versus 4%; p<0.001). Five of the 20 patients who underwent pH-metry presented with acid secretion from HGMs. These five patients had inlet patches of greater size. CONCLUSIONS HGMs of the upper esophagus are not infrequent, although generally small and asymptomatic. In cases of large HGMs, acid secretion capacity may cause upper esophageal disorders.
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Affiliation(s)
- Juan-Salvador Baudet
- Digestive Disease Service, Red Hospiten Tenerife, Santa Cruz de Tenerife, Canary Islands, Spain.
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Abstract
Heterotopic gastric mucosa patch (HGMP) has been reported to occur in various parts of the gastrointestinal system from mouth to anus. Extra-gastrointestinal locations have also been reported. Presence of ectopic gastric mucosa has been associated with complications such as ulceration, bleeding, perforations and malignant transformations. Most complications are probably related to acid production. Meckel diverticulum is the most commonly reported ectopic location. Similarly, esophageal HGMP, also known as cervical inlet patch (CIP), has been increasingly reported. Nonspecific oropharyngeal symptoms are common and thought to be due to laryngopharyngeal reflux. CIP is often missed due to its location in the esophagus, just distal to the upper esophageal sphincter, making endoscopic evaluation difficult. Hence the condition is most likely to be under-reported. This article presents a series of five cases of CIP and discusses the pathogenesis, clinical presentations and management of this interesting entity.
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Affiliation(s)
- Vui Heng Chong
- Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam.
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Bohr URM, Segal I, Primus A, Wex T, Hassan H, Ally R, Malfertheiner P. Detection of a putative novel Wolinella species in patients with squamous cell carcinoma of the esophagus. Helicobacter 2003; 8:608-12. [PMID: 14632676 DOI: 10.1111/j.1523-5378.2003.00186.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Certain regions of South Africa exhibit an extraordinarily high incidence of esophageal carcinoma that develops via an esophagitis-dysplasia-carcinoma sequence. Bacteria belonging to the family Helicobacteraceae are candidates for involvement in the initiation of the esophagitis. We investigated patients with esophageal carcinoma for the occurrence of Helicobacter-related species. METHODS Biopsies from tumor and nonlesional tissue of the esophagus from nine patients with squamous cell carcinoma were investigated for Helicobacteraceae using a PCR-based method targeting the 16S rRNA gene. RESULTS Four out of nine patients tested negative, while samples from the other five patients revealed an infection by different Helicobacter species. Sequence analysis of the PCR fragments led to the identification of a hitherto unknown bacterium in three of these patients. Phylogenetically, this bacterium was assigned to the genus Wolinella within the family of Helicobacteraceae. Helicobacter pylori was identified in three patients, and one revealed a coinfection with the novel Wolinella species. CONCLUSIONS Helicobacteraceae were detected in approximately 50% of South African patients with esophageal carcinoma. Furthermore, a novel bacterium was identified that might be linked to the enhanced incidence of esophagitis and subsequent malignant disease in South Africa.
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Affiliation(s)
- Ulrich R M Bohr
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
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