Gastric mucosa in upper esophagus frequent but rarely problematic

MedWire News: Around 10% of patients who undergo endoscopy of the upper gastrointestinal tract have at least one heterotopic gastric mucosa, a more frequent rate than previously reported, study results show.

However, the presence of gastric mucosa seemed to be rarely the cause of clinical symptoms and was not prone to complications, report Uwe Weickert (Academic Hospital of the University of Heidelberg, Heilbronn, Germany) and co-workers in the journal Diseases of the Esophagus.

The presence of gastric mucosa (also known as a gastric inlet patch) in the upper third of the esophagus in some patients is well recognized; however, the frequency of this finding and its clinical significance is uncertain.

Since heterotopic gastric mucosa is capable of mucin and acid production, it could feasibly be the cause of esophagitis with heartburn or dysphagia in the upper part of the esophagus.

To investigate, Weickert et al conducted a prospective study of 300 patients referred to endoscopy for symptoms thought to be coming from the upper gastrointestinal tract, including recurring indigestion, heartburn, pains in the upper abdomen, repeated vomiting, and dysphagia.

A total of 33 (11%) patients had at least one histologically proven gastric mucosa, with 17 patients having just one, nine patients two, five patients three, and one patient had four or five.

The diameter of gastric mucosa ranged from 3 to 25 mm, with an average of 12 mm. The average distance from the upper esophageal sphincter was 20 mm, ranging from 0 to 45 mm.

In eight (24%) cases the gastric mucosa was classified as oxyntic, in five (15%) as mucoid, and in 20 (61%) as mixed type. Helicobacter pylori infection was not present in any of the cases and no dysplastic changes were found histologically, although focal intestinal metaplasia was present in one patient.

Patients with gastric mucosa did not significantly differ from those without in terms of clinical symptoms, including hiatal hernia, reflux esophagitis, Barrett's esophagus, gastric/duodenal ulcer, grade of heartburn, recurrent hoarseness, or dysphagia.

Weickert et al comment: "We conclude that the presence of heterotopic gastric mucosa in the proximal esophagus is a frequent finding in thoroughly performed endoscopy.

"However, clinical symptoms should not be thoughtlessly attributed to this finding as this entity is rarely the cause of complaints and little prone to complications."

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