Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch)

Abstract

Aim: To determine the prevalence of heterotopic gastric mucosa in the upper oesophagus (inlet patch) and the factors that may influence its finding. To study its macroscopic and microscopic characteristics and its relationship with symptoms and oesophago-gastroduodenal diseases.

Patients and methods: The study was carried out in two different prospective series of consecutive patients undergoing oesophagogastroduodenoscopy. The first 791 patients were examined by one medical practitioner who was aware of the existence of inlet patch entity and aimed to evaluate the prevalence of inlet patch. The second series of 687 patients was examined by another investigator who was aware of the existence of inlet patch entity and who was requested to refer all patients with inlet patch, but he was unaware of the existence of a study aimed at evaluating the prevalence of inlet patch. The heterotopic gastric mucosal patches identified in the upper oesophagus were photographed, biopsied and analysed according to the Sydney system score.

Results: The presence of an inlet patch was found in 0.29% (operator unaware) and 2.27% (operator aware) of prospectively evaluated patients. Inlet patches appeared as single areas in 12 patients, as twin areas in five, and as multiple areas in one patient. Their diameters ranged approximately from 3 to 25 mm. The average age of the patients (13 men) was 52.5 +/- 16.8 years. Five patients had an active or healed peptic ulcer and only one patient had reflux oesophagitis. Dysphagia or throat discomfort/heartburn represented the symptoms leading to upper endoscopy in only one patient. Six of seven patients with Helicobacter pylori infection in the stomach also presented the infection in the heterotopic gastric mucosa.

Conclusion: Heterotopic gastric mucosa in the upper oesophagus is not a rare condition. The frequency with which this condition is found during routine endoscopic examination is likely due to the reduced awareness of the examiner. The presence of inlet patches is scarcely correlated with specific symptoms and the patches are often infected by H. pylori, in patients with H. pylori positive gastritis.