Case Report

Cervical Inlet Patch: Case Series and Literature Review

Authors: Vui Heng Chong, MRCP, FAMS, Anand Jalihal, MBBS, DM

Abstract

Heterotopic gastric mucosa patch (HGMP) has been reported to occur in various parts of the gastrointestinal system from mouth to anus. Extra-gastrointestinal locations have also been reported. Presence of ectopic gastric mucosa has been associated with complications such as ulceration, bleeding, perforations and malignant transformations. Most complications are probably related to acid production. Meckel diverticulum is the most commonly reported ectopic location. Similarly, esophageal HGMP, also known as cervical inlet patch (CIP), has been increasingly reported. Nonspecific oropharyngeal symptoms are common and thought to be due to laryngopharyngeal reflux. CIP is often missed due to its location in the esophagus, just distal to the upper esophageal sphincter, making endoscopic evaluation difficult. Hence the condition is most likely to be under-reported. This article presents a series of five cases of CIP and discusses the pathogenesis, clinical presentations and management of this interesting entity.


Key Points


* Cervical inlet patch or heterotopic gastric mucosa of the esophagus is not uncommon, but is an under-recognized condition.


* Symptoms are mainly related to acid production.


* Management consists of acid suppression therapy.


* It is associated with significant complications such as bleeding, ulcerations, perforations and malignant transformations.

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References

1. Wetmore RF, Bartlett SP, Papsin B, et al. Heterotopic gastric mucosa of the oral cavity: a rare entity. Int J Pediatr Otorhinolaryngol 2002;66:139–142.
 
2. Steele SR, Mullenix PS, Martin MJ, et al. Heterotopic gastric mucosa of the anus: a case report and review of the literature. Am Surg 2004;70:715–719.
 
3. Byrne M, Sheehan K, Kay E, et al. Symptomatic ulceration of an acid producing esophageal inlet patch colonized by helicobacter pylori. Endoscopy 2002;34:514.
 
4. Bataller R, Bordas JM, Ordi J, et al. Upper gastrointestinal bleeding: a complication of ‘inlet patch mucosa' in the upper esophagus. Endoscopy 1995;27:282.
 
5. Noguchi T, Takeno S, Takahashi Y, et al. Primary adenocarcinoma of the cervical esophagus arising from heterotopic gastric mucosa. J Gastroenterol 2001;36:704–709.
 
6. Schimdt FA. De mammalium esophagus alque werticulo. Inaugural dissertation. Halle, in office, Bathenea, 1805.
 
7. Jabbari M, Goresky CA, Lough J, et al. The inlet patch: heterotopic gastric mucosa in the upper esophagus. Gastroenterology 1985;89:352–356.
 
8. Lauwers GY, Wahl SJ, Urmacher CD. Multifocal ectopic gastric mucosa of the cervical esophagus.Am J Gastroenterol 1991;86:793–794.
 
9. 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;12:745–749.
 
10. Borhan-Manesh F, Farnum JB. Incidence of heterotopic gastric mucosa in the upper oesophagus.Gut 1991;32:968–972.
 
11. Schridde H. Über Magenschleimhaut-Inseln vom Bau der Cardialdrüsenzone und Fundusdrüsenregion und den unteren, oesophagealen Cardialdrüsen gleichende Drüsen im obersten Oesophagusabschnitt. Virchows Arch A Pathol Arat Histopathol 1904;175:1–16.
 
12. Melato M, Ferlito A. Heterotopic gastric mucosa of the tongue and the oesophagus. ORL J Otorhinolaryngol Relat Spec 1975;37:244–254.
 
13. Lessells AM, Martin DF. Heterotopic gastric mucosa in the duodenum. J Clin Pathol 1982;35:591–595.
 
14. Wakiyama S, Yoshimura K, Shimada M, et al. Heterotopic gastric mucosa in a gallbladder with an anomalous union of the pancreatobiliary duct: a case report. Hepatogastroenterology 1998;45:1488–1491.
 
15. Emamian SA, Shalaby-Rana E, Majd M. The spectrum of heterotopic gastric mucosa in children detected by Tc-99m pertechnetate scintigraphy. Clin Nucl Med 2001;26:529–535.
 
16. De Angelis P, Trecca A, Francalanci P, et al. Heterotopic gastric mucosa of the rectum. Endoscopy2004;36:927.
 
17. Khan MA, Fitzgerald RJ. Heterotopic gastric tissue in the scrotum. J Urol 1996;155:2061.
 
18. Avidan B, Sonnenberg A, Chejfec G, et al. Is there a link between cervical inlet patch and Barrett's esophagus? Gastrointest Endosc 2001;53:717–721.
 
19. Galan AR, Katzka DA, Castell DO. Acid secretion from an esophageal inlet patch demonstrated by ambulatory pH monitoring. Gastroenterology 1998;115:1574–1576.
 
20. Gutierrez O, Akamatsu T, Cardona H, et al. Helicobacter pylori and heterotopic gastric mucosa in the upper esophagus (the inlet patch). Am J Gastroenterol 2003;98:1266–1270.
 
21. Yarborough CS, McLane RC. Stricture related to an inlet patch of the esophagus. Am J Gastroenterol 1993;88:275–276.
 
22. Sanchez-Pernaute A, Hernando F, Diez-Valladares L, et al. Heterotopic gastric mucosa in the upper esophagus (‘inlet patch'): a rare cause of esophageal perforation. Am J Gastroenterol 1999;94:3047–3050.
 
23. Kohler B, Kohler G, Riemann JF. Spontaneous esophagotracheal fistula resulting from ulcer in heterotopic gastric mucosa. Gastroenterology 1988;95:828–830.
 
24. Pech O, May A, Gossner L, et al. Early stage adenocarcinoma of the esophagus arising in circular heterotopic gastric mucosa treated by endoscopic mucosal resection. Gastrointest Endosc2001;54:656–658.
 
25. Klaase JM, Lemaire LC, Rauws EA, et al. Heterotopic gastric mucosa of the cervical esophagus: a case of high-grade dysplasia treated with argon plasma coagulation and a case of adenocarcinoma. | Gastrointest Endosc 2001;53:101–104.