Gastric patch esophagus

Associations with chronic ear or sinus problem have also been reported. To date, there have only been a few studies that have reported comparisons of symptoms between patients with and without HGMPE. The symptoms enquired and reported were not consistent between studies.

Some reported the overall prevalence or limited to only one or few symptoms. However, most of the symptoms reported were mild. Prevalence rate of LPR symptoms as high as However, this study was limited by its retrospective nature and the assessment of only referral indications. The other studies were mainly from referral or specialized centers.

Prevalence of symptoms reported to be associated with heterotopic gastric mucosa of the proximal esophagus in adult. Currently, there are only a few studies on HGMPE in the pediatric population and are usually limited by small sample sizes[ 9 , 16 , 18 - 20 ].

Most are in the form of case reports[ 16 - 20 ]. Clinical manifestations are different from the adult population. Common manifestations include laryngospasm[ 16 ], respiratory symptoms[ 17 ] and dysphagia from reflux or stricture[ 9 , 20 ]. In one multicentre study that had looked at 15 patients with a median age 9.

Dysphagia and food impaction were the most common manifestations reported in 14 patients. Six patients had respiratory or ear, nose, and throat symptoms[ 9 ]. An autopsy study in the pediatric population showed that HGMPE was more common in younger age and was more significantly associated with unexplained death. Variend et al[ 26 ] speculated that pulmonary aspiration of esophageal contents may have been the cause of death in some of the children.

Three other studies[ 23 , 24 , 27 ] have reported significant positive correlations while five studies that included more than 20 patients with HGMPE have not found any correlations[ 3 , 8 , 22 , 25 , 28 ].

However, Fuerle et al[ 31 ] found some differences and postulated that the specialized columnar epithelium of Barrett's esophagus originates from a very immature multipotent gastrointestinal stem cell whereas HGMPE originates from remnant embryonic gastric mucosa located in the proximal esophagus.

Studies included are those with more than 10 patients with heterotopic gastric mucosa of the proximal esophagus HGMPE. Heartburn has been shown to be common in patients with HGMPE, even in those not found to have any erosive esophagitis[ 4 , 8 , 32 ].

Explanations offered included symptoms induced by acid secretion flowing downward or increased sensitivity as seen in non-erosive esophagitis. Apart from proximal acid reflux independent of distal acid reflux, Korkut et al[ 11 ] also showed that some patients with HGMPE have signs of esophageal motor dysfunction based on manometry and 24 h dual probe pH study.

They concluded that these abnormalities may be responsible for some of the symptoms experienced by patients with HGMPE. Patients with HGMPE had more and prolonged acid exposure in both proximal and distal esophagus, longer bile exposure time in the distal esophagus, reduced lower esophageal sphincter pressure with prolonged relaxation and decreased peristaltic wave amplitude. There was also increased number of simultaneous contractions in the esophageal body of patients with HGMPE.

The underlying pathogenesis is probably similar to those seen in acid-related gastric pathologies. In the pediatric population, HGMPE has also been associated with unexplained infant deaths[ 26 ], dysphagia from strictures in the proximal esophagus[ 9 , 18 , 20 ] or spasm[ 16 ] and recurrent neck abscesses secondary to fistula[ 19 ]. Complications of heterotopic gastric mucosa of the proximal esophagus reported in the literature.

References for type III cases reported in the literature not included in the reference list. Histological changes such as chronic inflammation[ 3 , 14 ], atrophy, intestinal metaplasia[ 14 ], and dysplasia[ 48 - 50 ] as seen in the stomach have been reported mainly in the adult population. However intestinal metaplasia has also been reported in children[ 17 ].

Macha et al[ 17 ] reported that 8. Neoplastic transformations have only been reported in the adult population[ 2 , 36 - 39 ]. To date, Neumann et al[ 24 ] in the largest series of endoscopies done in non-specialised centers did not encounter any cases of HGMPE with malignancy whereas Alagozlu et al[ 23 ] encountered a case each of adenocarcinoma and low grade dysplasia among 64 patients with HGMPE.

Based on these two studies, it can be estimated that the incidence of malignancies among patients with HGMPE ranges between 0 and 1. However, the incidence is likely to be much lower than the estimate from the latter study. Based on a review of 43 cases reported in the literatures by Akanamu et al[ 54 ], majority of those affected were men Most of the lesions were advanced at diagnosis especially in the earlier reported.

Early lesions T1 lesion accounted for 14 cases[ 54 ]. The lesions were ulcerated in Dysphagia was the most common compliant Interestingly, acid-related symptoms were not common. Smoking appeared to be a risk factor. To date, association with extra-esophageal neoplasms have only been reported twice[ 55 , 56 ]. Basseri et al[ 55 ] reported the case of a year-old lady with asthma and GERD diagnosed with laryngeal adenocarcinoma.

In another report, Satoh et al[ 56 ] reported the case of a year-old lady with hypopharyngeal carcinoma with a HGMPE 2. Chronic irritation from acid was proposed as the contributing cause to the development of the tumors.

HGMPE was first reported by Schmidt et al[ 1 ] as an aberrant gastric fundus-type epithelium located in the proximal esophagus. Despite this, the number of publications on this entity has remained low compared to the other esophageal disorders. Therefore it is not surprising that controversies remain regarding the clinical significance of this entity.

Despite the lack of data, HGMPE is clinically significant and the clinical significance is related to acid-related manifestations, mucosal changes and malignant transformations. On the other hand, these symptoms are chronic and very troublesome for a small minority of patients. It is currently uncertain if the symptoms are acid-related given that studies have shown that only a small proportion of symptomatic patient have documented acid secretion from the HGMPE[ 10 , 31 ].

However, one can probably surmise that there is a causal association. Symptomatic patients with HGMPE typically reports LPR symptoms; globus pharyngeus, sore throat, hoarseness, chronic cough, throat clearing and dysphagia[ 57 ].

The laryngopharyngeal complex is particularly sensitive and even a small amount of weakly acidic secretion can cause symptoms[ 57 , 58 ]. Symptoms can also occur with non-acidic secretions[ 4 ].

Presence of gastric enzymes such as pepsin also contributes to irritations[ 58 ]. Comparisons of published studies are difficult due to differences in the study methodologies. Symptoms enquired were not always consistent with some studies enquiring on limited number of symptoms or not specifying the symptoms enquired. Furthermore, most studies had small sample sizes. In clinical practice, we also often encounter patients with LPR symptoms without any heartburn.

Such patients are categorized as having extra-esophageal manifestations of GERD. Associations with neoplastic changes and importantly malignant transformation are reported and these represent the most significant associations of HGMPE.

However, the numbers reported is still very low and are considered extremely rare. Interestingly, a large number of the reported cases especially in the non-English literatures have been from Japan[ 54 ].

It may be related to better screening program and increased detection rate. Most of the reported cases were advanced at diagnosis especially in the earlier studies. However, there were more early cancers T1 lesions reported in the latter part. Men seem to be more at risk and smoking appears to be a risk factor[ 54 ].

Dysphagia was the main complaint leading to detection of tumors. Further large population studies will be required and help shade some lights into this controversy. Associations with other acid related complications such as erosions, ulcerations, bleeding, perforation, fistula and stricture formations have been documented[ 1 , 8 ]. Given that HGMPE mainly manifests with upper autodigestive symptoms, it is not unexpected that only clinicians from certain specialties such as the gastroenterologists, otorhinolaryngologists and rarely upper gastrointestinal surgeons will encounter such patients.

However, it is important that other clinicians from the other specialties to be aware of this entity especially when they come across patients with troublesome LPR symptoms.

Establishing a diagnosis is important as it can provide reassurance. This may also lead to symptoms improvement and avoid any further unnecessary investigations or consultations.

As the awareness of HGMPE increase, more asymptomatic or symptomatic cases will be diagnosed and with the ageing population, it is very likely the number of cases of neoplastic transformations will also increase, albeit a small increase. The clinical significance of HGMPE lies mainly with its capacity to produce acid and mucosal progressions to dysplasia and frank neoplastic transformation. Currently, there are still many areas of HGMPE that are not well understood and further research are required.

Symptomatic patients should to be treated and those found to have metaplasia or dysplasia may need to be considered for surveillance. National Center for Biotechnology Information , U. Journal List World J Gastroenterol v. No treatment is required for asymptomatic inlet patches. However, follow-ups may need to be considered for patients with complications of GIPs. Adult Symptoms Child Symptoms.

If you have any problem, please consult your doctor. Keywords: gastric inlet patch in esophagus. Most HGMPE are asymptomatic and are detected incidentally during endoscopy for evaluations of other gastrointestinal complaints. However, most of these symptoms are mild.

Clinically significant acid related complications such as bleeding, ulcerations, structure and fistulization have been reported.