Ectopic gastric mucosa in the cervical esophagus

Upper airway obstructive symptoms because of ectopic gastric mucosa in a newborn: a case report

“…Ectopic gastric mucosa, initially described by Schmidt in 1805, can occur in the fore-, mid-, and hindgut and conceivably in any of their derivatives [1][2][3][4].The origin of EGM is either heterotropic (congenital) or metaplastic (acquired), based on the immunohistochemical expression of the lesion [3,4]. The embryonic esophagus originates from the foregut and is initially lined by a stratified columnar epithelium, which is progressively replaced by ciliated and finally stratified squamous epithelium.…”

“…This modification begins in the middle esophagus of the embryonic neck in concert with the descent of the stomach and spreads in both a caudal and cephalic direction until the entire esophagus becomes lined with squamous epithelium. A failure in this embryologic process leads to the persistence of a poorly differentiated epithelium, corresponding to heterotropic gastric foci, which can be of cardial or fundic types [3,4].…”

“…Ectopic gastric mucosa is a benign condition that is rather common [2,4], usually asymptomatic but rarely can produce a variety of symptoms, including retrosternal pain, dysphagia, cricopharyngeal spasm, and laryngeal symptoms (cough and dyspnea) as a result of the damaging effect of acid production by parietal cells [3,4]. Complications such as ulceration [1], peptic stenosis, tracheobronchial fistula, and spontaneous perforations have been described, as well as Helicobacter pylori colonization [3,5].…”

“…Complications such as ulceration [1], peptic stenosis, tracheobronchial fistula, and spontaneous perforations have been described, as well as Helicobacter pylori colonization [3,5]. Endoscopy and biopsy for histologic evaluation are essential for diagnosis: the presence of ectopic columnar glandular epithelium in the esophagus is suggestive of EGM, but only the presence of parietal cells can confirm the diagnosis [2,4]. In our case, the lesion was not identified on the first laryngoscopic examination, possibly because of the long period of tracheal intubation that may have provoked edema of the entire upper airway resulting in temporary compression of the mucosal fold and thus led to a delay in diagnosis.…”

“…Symptoms can be successfully relieved with antihistamine (H 2 ) blockers or proton pump inhibitors [2,4], but if appropriate medical therapy fails, transcervical or endoscopic biopsy and/or excision is justified [4] especially if a small focus of malignancy is suspected, although the malignant transformation is very rare [3,4,6].…”