An unusual case of upper type dysphagia

Česká verze

Authors: Linter R. ¹; Kubát J. ¹; Mezera V. ²; Vyhnálek P. ¹
Authors place of work: Interní oddělení, Pardubická nemocnice2 Geriatrické centrum, Pardubická nemocnice ¹
Published in the journal: Gastroent Hepatol 2020; 74(3): 250-255
Category: Klinická a experimentální gastroenterologie: kazuistika
doi: https://doi.org/10.14735/amgh2020250

Summary

Inlet patch (IP) is an area of heterotopic gastric mucosa outside of its normal location. It probably originates during the 11^th week of embryogenesis as a disruption of mucosal layers. Inlet patch can be located anywhere in the gastrointestinal tract, from oral cavity all the way to the anus. The most frequent location of IP is the proximal esophagus. The prevalence of heterotopic gastric mucosa ranges from 0.9 to 15%. The presence of IP is mostly asymptomatic. However, some patients can experience hoarseness, cough, feeling of an obstactle in the throat or a sore throat. The pathogenesis arises from hypersecretion of gastric acid by parietal cells within the IP resulting into inflammatory infiltrate, ulceration, chronic strictures and even occasionaly into a malignant transformation. The diagnostics of this anomaly is based on meticulously performed endoscopy with a specific focus on proximal esophagus as well as by means of virtual chromoendoscopy. In our paper, we present a case report of a young male examined for chronic dysphagia and respiratory complaints. The initial ENT examination already revealed the cause of patient’s symptoms in the upper esophagus. During gastroscopy, there was a smooth stenosis of unusual, salmon-like color, which we were able to pass with the endoscope. Histology revealed a heterotopic gastric mucosa resembling gastric cardia. Considering his chronic dysphagia and recent aspiration pneumonia, a dilatation was required. We also excluded malignant transformation. The dilatation was with a complete remission of patient’s symptoms. Repeated histology identified signs of intestinal metaplasia without dysplasia, so we let the patient for observation without intervention.

Keywords:

dysphagia – proton pump inhibitors – heterotopic gastric mucosa – inlet patch – benign esophageal stricture – peptic ulcer

Zdroje

1. Rector LE, Connerley ML. Aberrant mucosa in esophagus in infants and in children. Arch Pathol 1941; 31: 285.

2. Georges A, Coopman S, Rebeuh J et al. Inlet patch: clinical presentation and outcome in children. J Pediatr Gastroenterol Nutr 2011; 52 (4): 419–423. doi: 10.1097/MPG.0b013e3181f2a913.

3. Schridde H. Über Magenschleimhaut-Inseln vom Bau der Cardialdrüsenzone und Fundusdrüsenregion und den unteren, oesophagealen Cardialdrüsen gleichende Drüsen im obersten Oesophagusabschnitt. Virchows Arch Pathol Anat Physiol Klin Med 1904; 175: 1–16.

4. Sakitani K, Toyoshima O, Watanabe H. Mo1823 prevalence of heterotopic gastric mucosa in the cervical esophagus and its pathological characteristics. Gastroenterology 2014; 146 (5): S662–S663. doi: 10.1016/S0016-5085 (14) 62414-8.

5. Maconi G, Pace F, Vago L et al. Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch). Eur J Gastroenterol Hepatol 2000; 12 (7): 745–749.

6. Tong MC, Gao H, Lin JS et al. One-stop evaluation of globus pharyngeus symptoms with transnasal esophagoscopy and swallowing function test. J Otolaryngol Head Neck Surg 2012; 41 (1): 46–50.

7. Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol 2013; 19 (3): 331–338. doi: 10.3748/wjg.v19.i3.331.

8. Feurle GE, Helmstaedter V, Buehring A et al. Distinct immunohistochemical findings in columnar epithelium of esophageal inlet patch and of Barrett‘s esophagus. Dig Dis Sci 1990; 35 (1): 86–92. doi: 10.1007/BF01537228.

9. Meining A, Bajbouj M. Erupted cysts in the cervical esophagus result in gastric inlet patches. Gastrointest Endosc 2010; 72 (3): 603–605. doi: 10.1016/j.gie.2010.05.008.

10. Alagozlu H, Simsek Z, Unal S et al. Is there an association between Helicobacter pylori in the inlet patch and globus sensation? World J Gastroenterol 2010; 16 (1): 42–47. doi: 10.3748/wjg.v16.i1.42.

11. 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 (4): 292–296. doi: 10.1016/j.dld.2011.11.008.

12. Chong VH, Jalihal A. Heterotopic gastric mucosal patch of the esophagus is associated with higher prevalence of laryngopharyngeal reflux symptoms. Eur Arch Otorhinolaryngol 2010; 267 (11): 1793–1799. doi: 10.1007/s00405-010-1259-2.

13. Lujan G, Genta R. The inlet patch revisited: a clinicopathologic study of 569 patients with heterotopic gastric mucosa in the proximal esophagus. Am J Gastroenterol 2010; 105: 0002–9270.

14. Cheng CL, Lin CH, Liu NJ et al. Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images. World J Gastroenterol 2014; 20 (1): 242–249. doi: 10.3748/wjg.v20.i1.242.

15. Rosztóczy A, Izbéki F, Németh IB et al. 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 (6): 498– 504. doi: 10.1111/j.1442-2050.2011.01281.x. 16 Korkut E, Bektaş M, Alkan M et al. Esophageal motility and 24-h pH profiles of patients with heterotopic gastric mucosa in the cervical esophagus. Eur J Intern Med 2010; 21 (1): 21–24. doi: 10.1016/j.ejim.2009.10.009.

17. Avidan B, Sonnenberg A, Chejfec G et al. Is there a link between cervical inlet patch and Barrett‘s esophagus? Gastrointest Endosc 2001; 53 (7): 717–721. doi: 10.1067/mge.2001.114782.

18. Wojciech Latos et al. 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. Wspolczesna Onkol 2013; 17 (2): 171–175. doi: 10.5114/wo.2013.34376.

19. Georgina E. Riddiough et al. Gastric adenocarinoma of the upper oesophagus: A literature review and case report. Int J Surg Case Rep 2017; 30: 205–214. doi: 10.1016/j.ijscr.2016.11.014.

20. Gutierrez O, Akamatsu T, Cardona H et al. Helicobacter pylori and hetertopic gastric mucosa in the upper esophagus (the inlet patch). Am J Gastroenterol 2003; 98 (6): 1266–1270. doi: 10.1111/j.1572-0241.2003.07488.x.

21. Borhan-Manesh F, Farnum JB. Study of Helicobacter pylori colonisation of patches of heterotopic gastric mucosa (HGM) at the upper esophagus. Dig Dis Sci 1993; 38 (1): 142–146. doi: 10.1007/BF01296787.

22. Von Rahden BH, Stein HJ, Becker K et al. Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinico-pathologic classification. Am J Gastroenterol 2004; 99 (3): 543–551. doi: 10.1111/j.1572-0241.2004.04082.x.

23. Bajbouj M, Becker V, Eckel F et al. Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations. Gastroenterology 2009; 137 (2): 440–444. doi: 10.1053/j.gastro.2009.04.053.

24. Kadota T, Fujii S, Oono Y et al. Adenocarcinoma arising from heterotopic gastric mucosa in the cervical esophagus and upper thoracic esophagus: two case reports and literature review. Expert Rev Gastroenterol Hepatol 2016; 10 (3): 405–414. doi: 10.1586/17474124.2016.1125780.

25. Dunn JM, Sui G, Anggiansah A et al. Radiofrequency ablation of symptomatic cervical inlet patch using a through-the-scope device: a pilot study. Gastrointest Endosc 2016; 84 (6): 1022–1026. doi: 10.1016/j.gie.2016.06.037.

26. 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 (5): 442–447. doi: 10.1111/dote.12221.

27. Guider J, Scott L. Esophageal Rings and Stricture Related to a Circumferential Inlet Patch. ACG Case Rep J 2016; 3 (4): e124. doi: 10.14309/crj.2016.97.