The Clinical Characteristics Of Heterotopic Gastric Mucosa In Esophagus

Heterotopic gastric mucosa(HGM)in the cervical esophagus,also referred to as “inlet patch” or “cervical inlet patch”,is characterized by the presence of columnar gastric mucosa in the upper esophagus,which was considered as geneogenous.Most of the patients were diagnosed under gastric endoscopy incidentally,and usually asymptomatic or with mild symptoms in gastrointestinal tract.HGM is often missed during endoscopy as the proximal esophagus is often neglected or briefly examined during routine endoscopic examination.There are few studies and clinical data about it,and now no clear conclusion has been reached on the etiology and clinical characteristics of the heterotopic gastric mucosa in esophagus.AIM: The aim of this study was to investigate the relationship between HGM and laryngopharyngeal reflux(LPR)symptoms,as well as the histological mechanism of HGM.Patients and methods:Nine hundred and fifty-eight patients(478 male,480 female;mean age 47.09 years,range 19–71)with upper gastrointestinal symptoms had elective esophagogastroduodenoscopy and the cervical esophagus was examined for the patch during withdrawal of the endoscope.Biopsies were obtained from the patch in 30 patients.Questionnaire for GERD-Q and Reflux Symptom Index(RSI)were completed by all the patients.Results:(1)According to the GERD-Q score and endoscopic diagnosis,all the patients were divided into control group(n=465),GERD group(n=316),HGM group(n=101)and HGM+GERD group(n=76).There was no significant difference on age,the duration of symptoms or living habit among these 4 groups.(2)The occurrence rate of LPR symptoms in these 4 groups were 29.68%,34.49%,52.48% and 85.53% respectively(P<0.05 between HGM/control groups and HGM+GERD/GERD groups).The most common symptoms in HGM patients were clearing your throat,coughing after eating or after lying down,and sensations of something sticking in your throat or a lump in your throat.(3)The LPR symptoms were related to the histological type of HGM.Fifteen samples showed mainly cardia gland,5 samples showed mainly pyloric gland,9 showed mixed type,and 1 was squamous epithelium.Conclusion: This study shows that males are more susceptible to heterotopic esophagogastric mucosa than females.The most common extraesophageal symptoms are persistent throat cleaning,globus sensation and unexplained and persistent cough,and the incidence of gastroesophageal reflux symptoms such as heartburn,reflux,chest pain and indigestion was also higher.Biopsy showed that the heterotopic mucosal pathology was mainly gastric fundus gland with acid secretion ability.Patients with esophagogastric mucosa are more likely to develop gastroesophageal reflux disease.