Heterotopic gastric mucosa in the cervical esophagus (inlet patch): Endoscopic prevalence, histological and clinical characteristics

Akbayir, Nihat; Alkım, Canan; Erdem, Levent; Sökmen, H. Mehmet; Sungun, Ayşim; Başak, Tülay; Turgut, Suat; Mungan, Zeynel

doi:10.1111/j.1440-1746.2004.03474.x

Cited by 112 publications

(108 citation statements)

References 28 publications

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“…Microscopically, the patch can be lined with fundic or gastric body type glands (1)(2)(3). The prevalence of EGM ranges www.bjournal.com.br from 0.1 to 4.9% in most series, reaching 10% in a prospective study (1)(2)(3). The presence of Helicobacter pylori has been reported in 20 to 56.5% of cases (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

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Over-expression of cyclooxygenase-2 in endoscopic biopsies of ectopic gastric mucosa

Martins

Neto

Oshima

et al. 2007

Braz J Med Biol Res

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Ectopic gastric mucosa (EGM) is considered to be a congenital condition. Rare cases of adenocarcinoma have been described. There are no data justifying regular biopsies or follow-up. Cyclooxygenase-2 (COX-2) is a protein involved in gastrointestinal tumor development by inhibiting apoptosis and regulating angiogenesis. The aim of this prospective study was to evaluate COX-2 expression in EGM and compare it with normal tissue and Barrett's esophagus. We evaluated 1327 patients. Biopsies were taken from the inlet patch for histological evaluation and from the gastric antrum to assess Helicobacter pylori infection. Biopsies taken from normal esophageal, gastric antrum and body mucosa and Barrett's esophagus were retrieved from a tissue bank. EGM biopsies were evaluated with respect to type of epithelium, presence of H. pylori, and inflammation. COX-2 was detected by immunohistochemistry using the avidin-biotin complex. EGM islets were found in 14 patients (1.1%). Histological examination revealed fundic type epithelium in 58.3% of cases, H. pylori was present in 50% and chronic inflammation in 66.7%. Expression of COX-2 was negative in normal distal esophagus, normal gastric antrum and normal gastric body specimens (10 each). In contrast, EGM presented over-expression of COX-2 in 41.7% of cases and Barrett's esophagus in 90% of cases (P = 0.04 and 0.03, respectively). COX-2 immunoexpression in EGM was not related to gender, age, epithelium type, presence of inflammation or intestinal metaplasia, H. pylori infection, or any endoscopic finding. Our results demonstrate up-regulation of COX-2 in EGM, suggesting a possible malignant potential of this so-called harmless mucosa.

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Section: Introductionmentioning

confidence: 99%

“…It presents as either a single or multiple patches localized just below the upper esophageal sphincter. Microscopically, the patch can be lined with fundic or gastric body type glands (1)(2)(3). The prevalence of EGM ranges www.bjournal.com.br from 0.1 to 4.9% in most series, reaching 10% in a prospective study (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

Over-expression of cyclooxygenase-2 in endoscopic biopsies of ectopic gastric mucosa

Martins

Neto

Oshima

et al. 2007

Braz J Med Biol Res

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“…One study that had looked specifically at patients with laryngopharyngeal reflux found significantly more HGMP/CIP in patients than controls, those without LPR symptoms (11.4% vs. 1.6%, p<0.05). These patients also had significantly more laryngeal acid reflux documented on pH study (Akbayir N. et al, 2004). Similarly, other studies have found more laryngopharyngeal reflux symptoms in patients with HGMP/CIP (Akbayir et al, 2004;Baudet et al, 2006;Borhan-Manesh & Franum, 1993;Tang et al, 2004).…”

Section: Clinical Manifestationsmentioning

confidence: 62%

“…In contrast, MUC5AC positivity was noted on the surface, pits and the glands of Barrett's esophagus. The HGMP/CIP can also be colonized by Helicobacter pylori and the patches are subjected to changes that are seen in the stomach (Akbayir et al, 2004;Alagozlu et al, 2010;BorhanManesh & Franum, 1991Gutierrez et al, 2003;Jacobs et al, 1997;Maconi et al, 2000;Poyrazoglu et al, 2009;Tang et al, 2004;Yüksel et al, 2008). Chronic inflammatory changes can be seen and progression to atrophy, intestinal metaplasia, dysplasia and malignant transformation have been reported (Borhan-Manesh & Franum, 1991).…”

Section: Histologymentioning

confidence: 99%

Heterotopic Gastric Mucosal Patch of the Proximal Esophagus

Chong¹

2011

Gastrointestinal Endoscopy

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“…The second condition is heterotopic gastric mucosa (HGM) more frequently associated with the cervical esophagus (3). Its appearance varies from tiny microscopic foci to large areas of red or salmon-red mucosa.…”

Section: Introductionmentioning

confidence: 99%

Long segments of columnar-lined lower esophagus are not always metaplastic

Pereira¹,

Correia²,

Amaro³

et al. 2015

Rev Esp Enferm Dig

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The presence of columnar epithelium in the esophagus is associated with two conditions: Barrett's esophagus and heterotopic gastric mucosa. The former results from the metaplastic replacement of the normal distal squamous esophageal lining, is associated with gastroesophageal reflux and is a pre-neoplastic condition. The second is thought as a congenital condition, resulting from the incomplete squamous epithelialization of the esophagus during embryologic development. It is found mainly in the cervical esophagus. Histologically, Barrett's esophagus is composed of an admixture of cardiac mucosa, oxintocardiac mucosa and intestinal metaplasia. Most of heterotopic gastric mucosa consists of oxyntic mucosa where the mucosal glands are straight and composed of parietal and chief cells.There are few reports of heterotopic gastric mucosa in the lower esophagus, generally presenting as small islands.In the present report, a series of four cases of large lower esophageal heterotopic gastric mucosa is described. All patients were initially misdiagnosed with Barrett's esophagus and referred for surveillance. The correct diagnosis was based in endoscopic and histological features. In all, a circular tiny strip of squamous mucosa was observed at endoscopy between the lower end of the columnarlined esophagus and the esophagogastric junction, defined as the proximal end of the gastric folds. Biopsy samples taken from the columnar-lined segments of the four patients showed pure oxyntic mucosa.When columnar-lined esophagus is observed in the distal esophagus not in continuity with gastric mucosa, the diagnosis of heterotopic gastric mucosa must be thought and confirmed histologically by the presence of pure oxyntic mucosa.

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Heterotopic gastric mucosa in the cervical esophagus (inlet patch): Endoscopic prevalence, histological and clinical characteristics

Abstract: Heterotopic gastric mucosal patches in the proximal esophagus should not be overlooked during endoscopy because they may lead to important complications in relation to their acid secretion, which may vary according to their parietal cell mass.

Cited by 112 publications

References 28 publications

Over-expression of cyclooxygenase-2 in endoscopic biopsies of ectopic gastric mucosa

Over-expression of cyclooxygenase-2 in endoscopic biopsies of ectopic gastric mucosa

Heterotopic Gastric Mucosal Patch of the Proximal Esophagus

Long segments of columnar-lined lower esophagus are not always metaplastic

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