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Giant esophageal inlet patch.

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A 35-year-old man presented to our clinic complaining of throat burning for years, with occasional solid food dysphagia. His symptoms were controlled with proton pump inhibitors (PPIs) taken four times daily. At another institution, a pH study demonstrated abnormal esophageal acid exposure, and a fundoplication was being considered. Transnasal esophagoscopy revealed a 270 [degrees] degree inlet patch with an associated stricture. He underwent balloon dilation of the stricture, continued his PPIs, and is doing well.

Heterotopic gastric mucosa (an inlet patch) can be found in various areas of the gastrointestinal system, but it is reported more frequently in the cervical esophagus. An inlet patch can be diagnosed clinically based on the endoscopic appearance of a salmon-red patch demarcated from the surrounding pearl-gray esophageal mucosa (figure) and histologically by the presence of gastric-type mucosa. It is likely an epidemiologic remnant of columnar epithelium lining the embryonic esophagus until it is replaced by squamous epithelium near the end of gestation.

The incidence of inlet patches is between 1 and 10%. (1,2) Usually they are asymptomatic; however, symptoms may include dysphagia, odynophagia, retrosternal pain, cricopharyngeal spasm, cough, and dyspnea. They can also lead to ulceration and stricture due to acid production. Gastric parietal cells of the ectopic gastric mucosa have been shown to produce pathophysiologic levels of acid, which can lead to the above-mentioned symptoms.

Acid suppression with PPIs has been shown to resolve symptoms effectively. Although a cervical inlet patch is not considered a premalignant lesion like Barrett metaplasia, it may be symptomatic and should be looked for during esophagoscopy.

References

(1.) von Rahden BH, Stein HJ, Becker K, et al. Heterotopic gastric mucosa of the esophagus: Literature-review and proposal of a clinicopathologic classification. Am J Gastroenterol 2004;99(3):543-51.

(2.) Poyrazoglu OK, Bahcecioglu IH, Dagli AF, et al. Heterotopic gastric mucosa (inlet patch): Endoscopic prevalence, histopathological, demographical and clinical characteristics. Int J Clin Pract 2007;63(2):287-91.

From the Center for Voice and Swallowing Disorders, Department of Otolaryngology, Georgia Health Sciences University, Augusta.

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Title Annotation:DYSPHAGIA CLINIC
Author:Morrison, Michele P.; Postma, Gregory N.
Publication:Ear, Nose and Throat Journal
Article Type:Case study
Geographic Code:1USA
Date:Aug 1, 2011
Words:337
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