Esophageal inlet patch. Radiol Res Pract. 2011;2011:460890. [PMID: 22091379 PMCID: PMC3197178 DOI: 10.1155/2011/460890]

Symptoms of Chronic Dysphagia Secondary to Multiple Cervical Inlet Patches and Esophageal Stricture

Ectopic gastric mucosa can be present throughout the gastrointestinal tract; however, when located within the upper esophagus, it is termed an esophageal inlet patch. To the best of our knowledge, most esophageal inlet patches occur as a single area of gastric mucosa. Here, we present a 44-year-old female who suffered from symptoms of chronic dysphagia and globus sensation for two years due to multiple inlet patches located in the cervical area of the upper esophagus with an associated cervical esophageal stricture. The patient underwent esophageal dilation and proton pump inhibitor therapy, resulting in a resolution of her symptoms. Our case demonstrates the appropriate clinical management of patients suffering from symptoms of chronic dysphagia due to multiple esophageal inlet patches. We recommend routine examination of the cervical esophagus in developing a differential diagnosis of inlet patch, especially in patients with chronic upper dysphagia.

Adenocarcinoma Arising From a Cervical Esophageal Inlet Patch: The Malignant Potential of a Small Lesion

Inlet patches (IP) are heterotopic lesions consisting of gastric mucosa. Commonly located in the cervical esophagus, it is believed that they are remnants of fetal columnar epithelium arising from incomplete replacement during embryogenesis. A rare complication of IP is the development of proximal esophageal adenocarcinoma. We report a case of a 59-year-old male with intractable cough and dysphagia that was found to have a malignant transformation of an IP.

Inlet patch mimicking unstable angina pectoris

The ectopic stomach mucosa island in the proximal esophagus, which is generally known as the inlet patch or cervical inlet patch, is called as the heterotopic gastric mucosa of the esophagus. Despite its asymptomatic progress, it may cause chest pain, shortness of breath and difficulty in swallowing due to the acid secretion from the ectopic mucosa. The study aimed to present a patient who underwent coronary angiography with an unstable angina pectoris diagnosis by cardiologists for gastric chest pain but found an inlet patch in gastroduodenoscopy.

Isl1 Regulation of Nkx2.1 in the Early Foregut Epithelium Is Required for Trachea-Esophageal Separation and Lung Lobation

The esophagus and trachea arise from the dorsal and ventral aspects of the anterior foregut, respectively. Abnormal trachea-esophageal separation leads to the common birth defect esophageal atresia with or without trachea-esophageal fistula (EA/TEF). Yet the underlying cellular mechanisms remain unknown. Here, we combine Xenopus and mouse genetic models to identify that the transcription factor Isl1 orchestrates trachea-esophageal separation through modulating a specific epithelial progenitor cell population (midline epithelial cells [MECs], Isl1+ Nkx2.1+ Sox2+) located at the dorsal-ventral boundary of the foregut. Lineage tracing experiments show that MECs contribute to both tracheal and esophageal epithelium, and Isl1 is required for Nkx2.1 transcription in MECs. Deletion of the chromosomal region spanning the ISL1 gene has been found in patients with abnormal trachea-esophageal separation. Our studies thus provide definitive evidence that ISL1 is a critical player in the process of foregut morphogenesis, acting in a small progenitor population of boundary cells.

Issues and controversies in esophageal inlet patch

The proximal esophagus is rarely examined, and its inspection is often inadequate. Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus, a region in which their prevalence is likely underestimated. Various studies have reported correlations between these esophageal marks with different issues such as Barrett's esophagus, but these findings remain controversial. Conflicting reports complicate the process of interpreting the clinical features of esophageal inlet patches and underestimate their importance. Unfortunately, the limited clinical data and statistical analyses make reaching any conclusions difficult. It is hypothesized that inlet patches are correlated with various esophageal and extraesophageal symptoms, diagnoses and the personalized therapeutic management of patients with inlet patches as well as the differential diagnosis for premalignant lesions or early cancers. Due to its potential underdiagnosis, there are no consensus guidelines for the management and follow up of inlet patches. This review focuses on questions that were raised from published literature on esophageal inlet patches in adults.

Cervical inlet patch: new insights into diagnosis and endoscopic therapy

The cervical inlet patch is an island of heterotopic gastric mucosa, most commonly found in the proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus sensation. This has led to a change in the Rome IV criteria for globus management, with emphasis on ruling out the condition. Proton pump inhibitors are often ineffective in resolving symptoms. Endoscopic studies on the use of ablative techniques, most recently radiofrequency ablation (RFA), have shown promise in reversing the CIP to mormal squamous mucosa, with subsequent symtpomatic resolution. The aim of this review is to update on the investigation and management of the CIP.

Clinical evaluation of twenty cases of heterotopic gastric mucosa of upper esophagus during five-year observation, using gastroscopy in combination with histopathological and microbiological analysis of biopsies

Aim of the study

Heterotopic gastric mucosa of the upper esophagus (HGMUE) may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. Furthermore, HGMUE may be the origin of malignant progression to cervical esophageal carcinoma.

Material and methods

In this work, 20 patients with diagnosed heterotopic gastric mucosa of the upper esophagus (HGMUE) were subjected to 5-year follow-up to determine the extent and structure of histopathological changes within HGMUEs, as well as HGMUE dysplasia and metaplasia, and risk of their malignant transformation. As a diagnostic tool to describe localization, form, size and surface feature of HGMUEs, endoscopy was used. At the same time, the biopsies were collected for histopathological and microbiological analysis.

Results

In examined patients, HGMUEs were associated with inflammation, chronic gastritis, hiatus hernia, duodenal bulb erosion and ulcer and infection of H. pylori. Intestinal metaplasia and low grade dysplasia were also indicated. During 5 years of observation, both the clinical and histopathological image of diagnosed HGMUEs was stable. The patients with detected presence of H. pylori were treated with triple or quadruple therapy.

These results show that HGMUEs may be associated with severe complications in the gastrointestinal tract, such as infection by H. pylori, hiatus hernia or duodenal ulcer. Although dysplasias and metaplasias found in diagnosed HGMUEs were not very numerous and relatively stable both clinically and histopathologically, at the present stage of the study we cannot exclude the possibility of HGMUE malignant transformation.