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Heterotopic Gastric Mucosa of the Proximal EsophaguAn Underrecognized Yet Clinically Significant Entity

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by

Vishnu
in

Introduction

Heterotopic Gastric Mucosa (HGM), also known as an inlet patch, is a rare but clinically relevant condition characterized by the presence of gastric mucosa within the upper esophagus. Although often discovered incidentally during endoscopy, its association with gastrointestinal symptoms and potential complications makes it a topic worth attention. A recent study published in the Annals of Clinical Gastroenterology and Hepatology sheds light on its prevalence, clinical features, and management strategies. For more peer reviewed gastroenterology research and updates, visit https://www.gastrohepatoljournal.com/index.php/acgh.

Study Overview and Objectives

This monocentric descriptive study evaluated patients diagnosed with HGM in the proximal esophagus over a five-month period.

Read the full study at https://doi.org/10.29328/journal.acgh.1001014

Key Study Goals

  • Determine the prevalence of HGM
  • Assess clinical symptoms and endoscopic features
  • Evaluate histopathological findings
  • Identify associated epidemiological factors

A detailed analysis can also be explored within the journal’s main article archive at gastrohepatoljournal.

Prevalence and Demographics

Out of 736 patients undergoing gastroscopy

  • Prevalence: 1.3%
  • Gender distribution: 80% male predominance
  • Mean age: 55 years (range 26–69)
  • 20% were smokers

Although literature reports prevalence ranging from 0.1% to 13.8%, this study found HGM at the lower end of that spectrum.

Clinical Manifestations

Interestingly, 80% of patients were symptomatic.

Most Common Symptoms

  • Dyspepsia (66%)
  • Epigastric pain (50%)
  • Heartburn (33%)
  • Regurgitation (16%)

Upper gastrointestinal endoscopy was primarily indicated due to GERD related symptoms.

According to the American College of Gastroenterology, careful evaluation of atypical esophageal findings during endoscopy is crucial, especially when patients present with persistent reflux symptoms.

Endoscopic and Histological Findings

Endoscopic Appearance

HGM lesions were:

  • Salmon-red in color
  • Well-demarcated
  • Rounded or oval
  • Average size: 1.75 cm
  • Located 13–20 cm from the dental arches

Histopathological Features

Biopsy results revealed:

  • Fundic-type gastric mucosa in all cases
  • Chronic inflammation in 70%
  • Intestinal metaplasia in 30%
  • Helicobacter pylori in 10%
  • No dysplasia detected

The absence of dysplasia in this cohort is reassuring, though intestinal metaplasia suggests potential for malignant transformation in rare cases.

Pathogenesis – Congenital or Acquired

Two primary hypotheses exist:

Congenital origin Embryological misplacement of gastric mucosa

Acquired origin Metaplastic transformation due to chronic acid exposure

    Unlike Barrett’s esophagus, HGM appears distinct in pathophysiology, though management strategies may overlap in high-risk cases.

    Role of Advanced Endoscopic Techniques

    Studies show that Narrow Band Imaging (NBI) improves detection rates significantly compared to white-light endoscopy.

    The World Gastroenterology Organisation emphasizes the importance of enhanced imaging technologies for early identification of mucosal abnormalities, improving diagnostic accuracy and patient outcomes.

    Classification-Based Approach

    • Asymptomatic patients: No treatment required
    • Symptomatic cases: Proton pump inhibitors (PPIs)
    • Complicated lesions: Endoscopic intervention (APC or radiofrequency)
    • Dysplasia or cancer: Oncological management

    In this study:

    • 2 patients were asymptomatic
    • 8 symptomatic patients received PPI therapy
    • All showed good clinical progress
    • No complications were observed

    Clinical Implications

    Although generally benign, HGM can rarely be associated with:

    • Ulceration
    • Strictures
    • Fistula formation
    • Adenocarcinoma

    Given these possibilities, careful endoscopic withdrawal technique and biopsy sampling of suspicious proximal esophageal lesions are recommended.

    Key Takeaways

    • HGM prevalence in this study was 1.3%
    • Strong male predominance observed
    • Most patients were symptomatic
    • No dysplasia identified
    • Management remains debated due to limited long-term data

    Call to Action

    Heterotopic Gastric Mucosa may be underrecognized, but its clinical relevance is growing with improved endoscopic detection. Continued research and awareness are essential to optimize patient care.

    Explore more cutting-edge gastroenterology research at https://www.gastrohepatoljournal.com/index.php/acgh and join the conversation by sharing your thoughts in the comments below!

    Disclaimer:This content is generated using AI assistance and should be reviewed for accuracy and compliance before considering this article and its contents as a reference. Any mishaps or grievances raised due to the reusing of this material will not be handled by the author of this article

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