Diagnosis of heterotopic gastric mucosa of the upper esophagus and its effect on the laryngeal mucosa
Authors:
M. Enter 1
; J. Syrovátka 1
; M. Merenda 2
Authors‘ workplace:
Oddělení ORL a chirurgie hlavy a krku, Nemocnice AGEL Nový Jičín a. s.
1; Interní oddělení, Nemocnice AGEL Nový Jičín a. s.
2
Published in:
Otorinolaryngol Foniatr, 72, 2023, No. 3, pp. 136-142.
Category:
Original Article
doi:
https://doi.org/10.48095/ccorl2023136
Overview
Introduction: Heterotopic gastric mucosa of the proximal esophagus (IP – inlet patch) is an islet of gastric mucosa close to the upper esophageal sfincter. Its cells may be able to produce acids and digestive enzymes. Methodology: Prospective study from 2020–2021 follows patients of groups A and B who underwent gastroduodenal endoscopic procedure or direct esophagoscopy in general anesthesia. In group C, patients with confirmed inlet patch underwent ENT videoendoscopic procedure to asses any laryngeal mucosa damage. Results: The prevalence of IP in our group was determined to be 4.87%. We diagnosed 40 IPs out of 821 examinations performed. Group C does not show any signs of laryngeal mucosal damage in patients with inlet patch. Conclusion: The prevalence of IP in the Nový Jičín region was 4.87%. In our study group, we didn’t find any significant laryngeal mucosal damage in patients with IP. t is necessary to think about IP in patients with laryngopharyngeal reflux without the effect of conservative therapy as a possible cause of difficulties. In the treatment of extraoesophageal reflux, which is difficult to influence with conservative therapy, it is advisable to supplement the gastrofibroscopic examination with a focus on the evidence of IP and its biopsy.
Keywords:
heterotopic gastric mucosa – inlet patch – GERD – extraesophageal reflux – rigid esophagoscopy
Sources
1. Orosey M, Amin M, Cappell MS. A 14-Year Study of 398 Esophageal Adenocarcinomas Diagnosed Among 156,256 EGDs Performed at Two Large Hospitals: An Inlet Patch Is Proposed as a Significant Risk Factor for Proximal Esophageal Adenocarcinoma. Dig Dis Sci 2018; 63(2): 452–465. Doi: 10.1007/ s10620-017-4878-2.
2. Linter R, Kubát J, Mezera V et al. Neobvyklý případ dysfagie horního typu. Gastroent Hepatol 2020; 74(3): 250–255. Doi:10.14735/ amgh2020250.
3. Ciocalteu A, Popa P, Ionescu M et al. Issues and controversies in esophageal inlet patch. World J Gastroenterol 2019; 25(30): 4061–4073. Doi: 10.3748/ wjg.v25.i30.4061.
4. Rahden BH von, Stein HJ, Becker K et al. Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification. Am J Gastroenterol 2004; 99(3): 543–551. Doi: 10.1111/ j.1572-0241.2004.04082.x.
5. Chong VH, Jalihal A. Heterotopic gastric mucosal patch of the esophagus is associated with higher prevalence of laryngopharyngeal reflux symptoms. Eur Arch Otorhinolaryngol 2010; 267(11): 1793–1779. Doi: 10.1007/ s00405- 010-1259-2.
6. Latos W, Sieroń-Stołtny K, Kawczyk-Krupka A et al. Clinical evaluation of twenty cases of heterotopic gastric mucosa of upper esophagus during five-year observation, using gastroscopy in combination with histopathological and microbiological analysis of biopsies. Contemp Oncol 2013; 17(2): 171–175. Doi:10.5114/ wo.2013.34376.
7. Cock C, Hamarneh Z. Gastric inlet patches: symptomatic or silent? Curr Opin Otolaryngol Head Neck Surg 2019; 27(6): 453–462. Doi: 10.1097/ MOO.0000000000000581.
8. Maconi G, Pace F, Vago L et al. Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch). Eur J Gastroenterol Hepatol 2000; 12(7): 745–749. Doi: 10.1097/ 00042737-200012070-00005.
9. López-Colombo A, Jiménez-Toxqui M, Gogeascoechea-Guillén PD et al. Prevalence of esophageal inlet patch and clinical characteristics of the patients. Rev Gastroenterol Mex 2019; 84(4): 442–448. Doi: 10.1016/ j.rgmx.2018.07.003.
10. Weickert U, Wolf A, Schröder C et al. Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients. Dis Esophagus 2011; 24(2): 63–68. Doi: 10.1111/ j.1442-2050.2010.01091.x.
11. Basseri B, Conklin JL, Mertens RB et al. Heterotopic gastric mucosa (inlet patch) in a patient with laryngopharyngeal reflux (LPR) and laryngeal carcinoma: a case report and review of literature. Dis Esophagus 2009; 22(4): E1–E5. Doi: 10.1111/ j.1442-2050.2008.00915.x.
12. Chong VH. Cervical inlet patch: an important cause of Globus pharyngeus. Eur Arch Otorhinolaryngol 2018; 275(12): 3101–3102. Doi: 10.1007/ s00405-018-5132-z.
13. Cheng CL, Lin CH, Liu NJ et al. Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow--band images. World J Gastroenterol 2014; 20(1): 242–249. Doi:10.3748/ wjg.v20.i1.242.
14. Chung CS, Lin CK, Liang CC et al. Intentional examination of esophagus by narrow-band imaging endoscopy increases detection rate of cervical inlet patch. Dis Esophagus 2015; 28(7): 666–672. Doi: 10.1111/ dote.12252.
15. Sahin G, Adas G, Koc B et al. Is cervical inlet patch important clinical problem? Int J Biomed Sci 2014; 10(2): 129–135.
16. Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol 2013; 19(3): 331–338. Doi: 10.3748/ wjg.v19.i3.331.
17. Peitz U, Vieth M, Evert M et al. The prevalence of gastric heterotopia of the proximal esophagus is underestimated, but preneoplasia is rare – correlation with Barrett‘s esophagus. BMC Gastroenterol 2017; 17(1): 87. Doi: 10.1186/ s12876-017-0644-3.
18. Dunn JM, Sui G, Anggiansah A et al. Radiofrequency ablation of symptomatic cervical inlet patch using a through-the-scope device: a pilot study. Gastrointest Endosc 2016; 84(6): 1022–1026. Doi: 10.1016/ j.gie.2016.06.037.
19. Dziadkowiec KN, Sánchez-Luna SA, Stawinski P et al. Adenocarcinoma Arising From a Cervical Esophageal Inlet Patch: The Malignant Potential of a Small Lesion. Cureus 2020; 12(7): e9284. Doi: 10.7759/ cureus.9284.
20. Zeleník K, Komínek P, Stárek I et al. Extraezofageální reflux (2. část). ORL manifestace a léčba. Otorinolaryngol Foniatr 2008; 57(3): 151–158.
21. Zeleník K, Kopřivová H, Stárek I et al. Reflux Finding Score. Otorinolaryngol Foniatr 2010; 59(1): 28–31.
22. Zeleník K, Kopřivová H, Komínek P. Extraezofageální reflux: porovnání základních diagnostických metod (Reflux symptom index, Reflux finding score, diagnosticko-terapeutický test, pH-metrie). Otorinolaryngol Foniatr 2011; 60(2): 71–77.
23. Schmidt FFA. De mammalium oesophage atque ventriculo. Inaugural dissertation. Halle in off Bathenea. 1805.
24. Bajbouj M, Becker V, Eckel F et al. Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations. Gastroenterology 2009; 137(2): 440–444. Doi: 10.1053/ j.gastro.2009.04.053.
25. Rusu R, Ishaq S, Wong T et al. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol 2018; 9(3): 214–220. Doi: 10.1136/ flgastro-2017-100855.
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Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
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