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

Abstract

Aim of the studyHeterotopic 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 methodsIn 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.ResultsIn 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.

Issues and controversies in esophageal inlet patch

“…Fortunately, a five-year follow up of 20 patients with both cervical heterotopic gastric mucosa and H. pylori infection by Latos et al[36] did not find any malignant transformation, dysplasia or metaplasia. However, their study was potentially limited by a small patient population.…”

“…In a small case series, the detection of an IP web or ring suggested the pathogenesis of an acid-induced lesion[38]. Importantly, colonization with H. pylori may exacerbate these complications[31,36].…”

Laryngopharyngeal symptoms and oesophageal disorder: The role of heterotopic gastric mucosa in upper oesophagus

“…Galan et al 16 were the first investigators who demonstrated acid production of HGMUE islets without any stimuli, by 24‐h pH monitoring. The present study also confirmed that about 70% HGMUE samples showed oxyntic‐ or fundic‐type gland or mixed type, and more than 90% of them were positive staining of H + ‐K + ‐ATPase.…”

Heterotopic gastric mucosa of upper esophagus: evaluation of 12 cases during gastroscopic examination

“…The heterotopic, but otherwise not malignant, epithelium may advance to invasive carcinoma following a metaplasia-dysplasia-carcinoma sequence [ 21 ]. Although the numbers of dysplasia and metaplasia in the diagnosed HGM of the upper oesophagus were limited (about 9% and 12%, respectively), and these lesions were relatively stable clinically, at the present stage of the study we cannot exclude the possibility of malignant progression of HGM into adenocarcinoma of the upper oesophagus [ 22 ].…”