While gastric heterotopia has been described as occurring anywhere throughout the gastrointestinal tract, an asymptomatic finding in the rectum is exceedingly rare. Gastric heterotopia happens when gastric mucosa arrives in the wrong section of the GI tract during early fetal development. This condition can be asymptomatic or symptomatic, depending on the production of gastric acid and its effects on surrounding tissues. The presence of gastric heterotopia in an unfamiliar location can surprise the clinician with an unusual-appearing lesion. Its symptomology can also lead to unusual complaints whose etiology is only elucidated after biopsies. We report a rare case of a spread-out rectal lesion with heaped-up borders in an asymptomatic female who underwent colonoscopy screening.

In the United States, Korean Americans have the highest incidence rate of gastric cancer and have a five times higher risk than non-Hispanic Whites. Early detection is important for cancer treatment and survival.  In countries where there is a high prevalence of gastric cancer, such as Korea and Japan, national screening programs have been implemented. In the United States, immigrants of countries like Korea and Japan continue to have many of the same risk factors as in their home country.  However, recommendations for gastric cancer screening in the United States are lacking, even for these high-risk populations. We conducted a literature search of relevant information to identify appropriate screening measures and criteria for gastric cancer screening for Korean Americans. Based on the data from the Korean national screening program, the proportion of gastric cancers diagnosed at an earlier stage increased significantly. Furthermore, endoscopic screening was associated with a decrease of about 50% in gastric cancer death risk for those between 40 and 74 years old. Therefore, there is a similar need for screening for Korean Americans who have a similar diet and lifestyle as native Koreans. By increasing early detection, routine screening via endoscopy in high-risk Korean Americans may have a significant impact on decreasing the morbidity and mortality associated with gastric cancer, as seen in the Korean studies.