Heterotopic Gastric Mucosa of the Esophagus: Literature-Review and Proposal of a Clinicopathologic Classification

Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Germany.
The American Journal of Gastroenterology (Impact Factor: 10.76). 04/2004; 99(3):543-51. DOI: 10.1111/j.1572-0241.2004.04082.x
Source: PubMed


The prevalence of heterotopic gastric mucosa (HGM) in the cervical esophagus is frequently underestimated. Tiny microscopic foci have to be distinguished from a macroscopically visible patch, also called "inlet patch." Symptoms as well as morphologic changes associated with HGM are regarded as a result of the damaging effect of acid, produced by parietal cells in the mostly fundic type of HGM. We herein review the literature and propose a new clinicopathologic classification of esophageal HGM: Most of the carriers of esophageal HGM are asymptomatic (HGM I). Some individuals with HGM in the esophagus complain of dysphagia, odynophagia, or "extraesophageal manifestations" (hoarseness and coughing), without further morphologic findings (HGM II). Still fewer patients are symptomatic due to morphologic changes, i.e., esophageal strictures, webs, or esophagotracheal fistula (HGM III). Malignant transformation via dysplasia (intraepithelial neoplasia, HGM IV) to cervical esophageal adenocarcinoma (HGM V) is exceedingly rare (only 24 reported cases). In contrast to Barrett's esophagus, HGM should not be regarded as a precancerous lesion. Symptoms are more likely to occur in patients with inlet patch, whereas malignant transformation and adenocarcinogenesis can also occur in microscopic HGM foci. Asymptomatic HGM requires neither specific therapy nor endoscopic surveillance. Only in symptomatic cases treatment, i.e., dilatation for (benign) strictures or acid suppression for reflux symptoms, can be recommended. Patients with low-grade dysplasia in HGM might be candidates for surveillance strategies, whereas in cases of high-grade dysplasia and invasive adenocarcinoma oncological treatment strategies must be employed.

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    • "The “inlet patch” is found in 10% of the population with careful searching at endoscopy [14, 15] but its presence is often overlooked or underestimated by endoscopists so that studies frequently report a prevalence between 0.1 and 3% [1, 2, 16–18]. Thus, awareness and carefulness of the endoscopist considerably affect the detection rate of heterotopic gastric mucosa in the esophagus [2, 19]. "
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    ABSTRACT: 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. 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. 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.
    Contemporary Oncology / Wspólczesna Onkologia 04/2013; 17(2):171-175. DOI:10.5114/wo.2013.34376 · 0.22 Impact Factor
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    • "When it occurs in the upper esophagus, it is called “inlet patch” because of its location at or just distal to the upper esophageal sphincter. The inlet patch is considered a congenital anomaly found in 10% of the population with careful searching at endoscopy [3] but it is often overlooked by endoscopists and radiologists and studies frequently report a prevalence between 0.1 and 3% [1, 4–6]. Inlet patches are believed to be due to incomplete transformation from columnar to squamous epithelium during embryonic development [5]. "
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    ABSTRACT: An inlet patch is a congenital anomaly consisting of ectopic gastric mucosa at or just distal to the upper esophageal sphincter. Most inlet patches are largely asymptomatic, but in problematic cases complications related to acid secretion such as esophagitis, ulcer, web and stricture may occur. The diagnosis of inlet patch is strongly suggested on barium swallow where the most common pattern consists of two small indentations on the wall of the esophagus. The diagnosis of inlet patch is confirmed via endoscopy with biopsy. At endoscopy, the lesion appears salmon-coloured and velvety and is easily distinguished from the normal grey-white squamous epithelium of the esophagus. The prominent margins correlate with the radiological findings of indentations and rim-like shadows on barium swallow. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. No treatment is required for asymptomatic inlet patches. Symptomatic cases are treated with proton pump inhibitors to relieve symptoms related to acid secretion. Strictures and webs are treated with serial dilatation and should be biopsied to rule out malignancy.
    03/2011; 2011:460890. DOI:10.1155/2011/460890
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    • "Progression to adenocarcinoma is exceptional, with very few cases reported in the literature [2]. The symptoms described at presentation are dysphagia [2], stridor and dyspnea [10], recurrent episodes of sore throat, neck pain, and bronchitis. "
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    ABSTRACT: We report a unique case of ectopic gastric mucosa (EGM) in the cervical esophagus. The patient presented with a recurrent cervical abscess communicating through a fistula with the EGM. Surgical treatment consisted of complete excision. The postoperative course was complicated by a breach in the hypopharynx, which was treated conservatively, and a stenosis of the esophagus requiring balloon dilation.
    Journal of Pediatric Surgery 06/2010; 45(6):e15-7. DOI:10.1016/j.jpedsurg.2010.03.022 · 1.39 Impact Factor
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