An unusual case of upper type dysphagia

Czech version

Authors: Linter R. ¹; Kubát J. ¹; Mezera V. ²; Vyhnálek P. ¹
Authors‘ workplace: Interní oddělení, Pardubická nemocnice2 Geriatrické centrum, Pardubická nemocnice ¹
Published in: Gastroent Hepatol 2020; 74(3): 250-255
Category: Clinical and Experimental Gastroenterology: Case Report
doi: https://doi.org/10.14735/amgh2020250

Overview

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

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