CASE REPORT
Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction

https://doi.org/10.1016/S1081-1206(10)61049-6Get rights and content

Background

An inlet patch of gastric mucosa in the upper esophagus is usually an incidental, congenital finding found during upper gastrointestinal tract endoscopy. Although it has been reported to cause dysphagia, strictures, adenocarcinoma, and webs, it has never been associated with cough and vocal cord dysfunction.

Objective

To report the first case of a patient with an inlet patch of gastric mucosa in the upper esophagus as the cause of a particularly troublesome, chronic cough that was initially missed on 2 upper endoscopies.

Methods

The patient is a 50-year-old man with a 7-year history of chronic cough associated with hoarseness, shortness of breath, and globus sensation. For diagnostic evaluation, pulmonary function tests, chest computed tomography, rhinolaryngoscopy, upper gastrointestinal tract endoscopy, and histologic examinations were performed.

Results

A multidisciplinary approach revealed several possible causes for the chronic cough, including vocal cord dysfunction, postnasal drip syndrome, allergic rhinitis, and mild gastroesophageal reflux disease that was only partially responsive to therapy. The results of 2 initial upper gastrointestinal tract endoscopies were interpreted as normal. A third endoscopy detected an inlet patch of gastric mucosa in the upper esophagus. Treatment with a high-dose histamine type 2 receptor antagonist and a proton pump inhibitor alleviated the patient's symptoms.

Conclusions

An inlet patch of gastric mucosa in the upper esophagus is not uncommon, but it is often overlooked or believed to be an incidental, congenital finding. This is the first report, to our knowledge, of an inlet patch resulting in a troublesome, chronic cough.

REFERENCES (12)

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    No endoscopic or histological changes were evident in any of these patients. Traditionally considered a nonpathological incidental finding, IP has now been identified as the possible cause of unexplained digestive and respiratory symptoms, such as chronic cough, laryngospasm, sore throat, globus pharyngeus, dysphagia, hoarseness, and vocal cord dysfunction,2-7,9-12 at least in in a subgroup of patients. Moreover, case reports have shown that IP can play a role in the development of severe complications, such as webs, strictures, ulcers, perforation, fistulas, and adenocarcinoma.14-32

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