Acid suppressive therapy improved symptoms due to circumferential cervical inlet patch with proton pumps (H+/K+-ATPase)

Abstract

Cervical inlet patch (CIP), also referred to as esophageal heterotopic gastric mucosa, is regarded as the residue of columnar epithelium of the embryonic esophagus. Narrow band imaging increases the detection rate of CIP. Herein, we present a 55-year-old man with symptomatic circumferential inlet patch. He exhibited globus and dysphagia, and esophagogastroduodenoscopy found cir-cumferential CIP, where im-munohistochemistry revealed the existence of pro-ton pumps (H⁺, K⁺-ATPase). His throat symptoms were relieved by acid suppressive therapy with pump inhibitors. This case indicated that CIP should be considered as a differential diagnosis for the cause of globus symptoms in rare cases.

Keywords: Cervical inlet patch; Proton pump inhibitor.

Figure 1

Endoscopic image of circumferential cervical inlet patch. A: White light image showing circular reddish cervical inlet patch (CIP) mucosa; B: On narrow band imaging, CIP is the circular dark brown area and squamous mucosa is light green. This sharp contrast of color helps to detect CIP.

Figure 2

Histopathological findings of biopsy specimen. A: Endoscopic biopsy of cervical inlet patch (CIP) showing foveolar epithelium and fundic gland (Hematoxylin and eosin staining); B: Immunohistochemistry for proton pump alpha subunit demonstrated concentration of staining in glands of CIP (X 400).