Esophageal Inlet Patch

Abstract

An inlet patch is a congenital anomaly consisting of ectopic gastric mucosa at or just distal to the upper esophageal sphincter. Most inlet patches are largely asymptomatic, but in problematic cases complications related to acid secretion such as esophagitis, ulcer, web and stricture may occur. The diagnosis of inlet patch is strongly suggested on barium swallow where the most common pattern consists of two small indentations on the wall of the esophagus. The diagnosis of inlet patch is confirmed via endoscopy with biopsy. At endoscopy, the lesion appears salmon-coloured and velvety and is easily distinguished from the normal grey-white squamous epithelium of the esophagus. The prominent margins correlate with the radiological findings of indentations and rim-like shadows on barium swallow. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. No treatment is required for asymptomatic inlet patches. Symptomatic cases are treated with proton pump inhibitors to relieve symptoms related to acid secretion. Strictures and webs are treated with serial dilatation and should be biopsied to rule out malignancy.

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

“…Heterotopic gastric mucosa located of the upper esophagus (HGMUE) is also known as a cervical IP and was first described by Schumidt in 1805 [7,8]. The pathogenesis is widely considered to be congenital, although some studies suggest that metaplastic transformation may also be possible [9].…”

Inlet patch mimicking unstable angina pectoris

“…Many of the cervical IPs are asymptomatic; however, esophagitis, ulcer and web, which are associated with acid secretion, and pain in the chest and throat, dysphagia, sensation of globus and dyspnea -as a result of contraction in the esophagus-may develop (6). Probably, our patient developed esophageal irritation dependent on acid secretion and in turn reflux symptoms and pain in the chest.…”

“…Although most IPs are asymptomatic, they can cause chest pain and shortness of breath when they are acid-releasing (6). IP should be considered in the differential diagnosis of patients with chest pain complaints.…”

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

“…The “inlet patch” is found in 10% of the population with careful searching at endoscopy [14, 15] but its presence is often overlooked or underestimated by endoscopists so that studies frequently report a prevalence between 0.1 and 3% [1, 2, 16–18]. Thus, awareness and carefulness of the endoscopist considerably affect the detection rate of heterotopic gastric mucosa in the esophagus [2, 19].…”