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CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2022; 12(01): 90-92
DOI: 10.1055/s-0041-1731141
Case Report

Symptomatic Heterotopic Gastric Mucosa in Distal Esophagus

Avnish Kumar Seth
1   Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Mahesh Kumar Gupta
1   Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Gursimran Kaur
1   Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Priti Jain
1   Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Rinkesh Kumar Bansal
1   Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
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Abstract

Introduction Heterotopic gastric mucosa (HGM) in esophagus is commonly noted as an inlet patch at endoscopy. We describe a rare patient with symptomatic distal esophageal HGM.

Case Report A 40-year-old male presented with retrosternal pain and marked odynophagia for the last 4 weeks without any history of ingestion of antibiotics, foreign body, or corrosive. Endoscopy showed abrupt circumferential transition to salmon pink mucosa at 35 cm from incisors. From 35 to 41 cm, there were areas of polypoid edematous thickening with few superficial ulcers of 1 to 3 mm. Squamous epithelium was visualized at narrow band imaging from 41 cm to the Z-line at 43 cm with no hiatus hernia. Biopsy showed gastric-type mucosa with parietal cells without dysplasia. Serology for cytomegalovirus and human immunodeficiency virus was negative. He was managed with proton pump inhibitors (PPIs) and prokinetics and improved symptomatically. Follow-up endoscopy at 3 months demonstrated healing of ulcers with persistence of HGM and pseudopolyps. He remains well on maintenance with PPI at 1-year follow-up.

Conclusion Symptomatic HGM in distal esophagus is rare and can be differentiated from Barrett’s esophagus histologically and by presence of squamous epithelium between HGM and stomach. Inflammatory mass lesions may develop and mimic esophageal malignancy. Symptoms are largely due to acid production and usually respond to PPI.

Keywords

heterotopic gastric mucosa - distal esophagus - retrosternal pain


Publication History

Article published online:
14 June 2021

© 2021. Nitte (Deemed to be University). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Bajbout M, Meining A, Schmid R. Endoscopic diagnosis and treatment of intel patch: justification, techniques, and results. Tech Gastrointest Endosc 2014; 16 (01) 49-52
    CrossrefGoogle Scholar
  • 2 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 (02) 138-144
    CrossrefPubMedGoogle Scholar
  • 3 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 (42) e1722
    CrossrefPubMedGoogle Scholar
  • 4 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 (05) 442-447
    CrossrefPubMedGoogle Scholar
  • 5 Meining A, Bajbouj M. Erupted cysts in the cervical esophagus result in gastric inlet patches. Gastrointest Endosc 2010; 72 (03) 603-605
    CrossrefPubMedGoogle Scholar
  • 6 Avidan B, Sonnenberg A, Chejfec G, Schnell TG, Sontag SJ. Is there a link between cervical inlet patch and Barrett’s esophagus?. Gastrointest Endosc 2001; 53 (07) 717-721
    CrossrefPubMedGoogle Scholar
  • 7 von Rahden BH, Stein HJ, Becker K, Liebermann-Meffert D, Siewert JR. Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification. Am J Gastroenterol 2004; 99 (03) 543-551
    CrossrefPubMedGoogle Scholar
  • 8 Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011; 140 (03) 1084-1091
    CrossrefPubMedGoogle Scholar
  • 9 Alagozlu H, Simsek Z, Unal S, Cindoruk M, Dumlu S, Dursun A. Is there an association between Helicobacter pylori in the inlet patch and globus sensation?. World J Gastroenterol 2010; 16 (01) 42-47
    PubMedGoogle Scholar
  • 10 Yamada T, Tsuji A, Onoue S. et al Acid suppressive therapy improved symptoms due to circumferential cervical inlet patch with proton pumps (H+/K+-ATPase). World J Clin Cases 2017; 5 (11) 403-406
    CrossrefPubMedGoogle Scholar