Gastric Heterotopia in the Rectum

Abstract

Gastric heterotopia, which is not uncommonly seen, occurs anywhere in the alimentary tract as well as in the mediastinum, scrotum and spinal cord. Gastric heterotopia in the rectum, however, is rarely reported, with only about 40 cases published in the English literature. Although it is a rare entity, it may be the source for significant problems such as rectal bleeding, abdominal and rectal pain and malignancy. Therefore, it is important to recognize this entity. Here, we report an additional case of gastric heterotopia in the rectum of 65 year-old female and review the literature.

Asymptomatic gastric heterotopia in the rectum with Helicobacter pylori infection

“…Since the first report by Ewell and Jackson in 1939 [13], less than 50 cases of gastric heterotopia in the rectum have been reported [2,3,6,7,8]. To the best of our knowledge, only in six of them has H. pylori been observed [1,2,6,9,10,11] and in only one case has the presence of H. pylori been confirmed by immunohistochemistry [10].…”

“…In contrast to pyloric metaplasia, gastric heterotopia, composed of oxyntic-type mucosa with glands containing parietal and chief cells, is generally believed to be a developmental anomaly, not associated with chronic inflammatory conditions [1,2,3], but its exact origin remains unknown and its congenital nature is sometimes questioned. According to one theory, gastric heterotopia may result from the failure of descent of the embryonal foregut.…”

“…It is relatively often observed within intestinal duplications [1,4,5]. The location in the rectum is one of the rarest ones [2,3,6,7,8]. To our knowledge, only in six cases has the presence of Helicobacter pylori been revealed in heterotopic mucosa [1,2,6,9,10,11].…”

“…inflammatory bowel disease, duodenal peptic ulcer disease or chronic cholecystitis. These findings represent an acquired, reactive, adaptive change in the direction of cellular differentiation and therefore are regarded as metaplastic lesions [1,2,3]. The exception is Barrett esophagus, in which the presence of oxyntic mucosa is nowadays not interpreted as heterotopia, but as an example of metaplasia.…”

“…Gastric heterotopia is defined as the presence of gastric oxyntic mucosa outside of the stomach and is generally regarded as a congenital malformation [1,2,3]. It should be distinguished from the gastric-type surface and foveolar epithelium and/or non-specialized antral-type mucosa that may occur in various parts of the digestive system in the course of various chronic inflammatory conditions, e.g.…”