New methodsClinical endoscopy: EditorialGastric inlet patches in the cervical esophagus: what they are, what they cause, and how they can be treated
Section snippets
Definition, histology, pathogenesis
Gastric inlet patches (GIPs) comprise islands of heterotopic gastric columnar epithelium in the cervical esophagus. They are often found incidentally at upper endoscopy and have a reported prevalence of 1% to 12%.1, 2 Factors associated with a higher detection rate of GIPs are the awareness of the endoscopist in finding this mucosal alteration as well as the use of modern endoscopes (high-definition endoscopes and the additional application of virtual chromoendoscopy).2 The histologic
Do GIPs cause symptoms? what symptoms are attributable to GIPs?
Given that around 10% of all human beings worldwide have to be classified as GIP carriers, it is remarkable that only a very few of them become symptomatic. The diagnosis of GIP is usually made by chance during upper-GI endoscopy performed for other reasons. Nevertheless, in some cases, GIPs can cause local mucosal alterations (eg, strictures, ulcers, fistula, neoplasia) that cause symptoms like pain or dysphagia.
The question of whether symptoms like globus sensations, chronic cough,
Whom, when, and how should we treat?
Most GIPs are found with no attributable symptoms. In the current issue of Gastrointestinal Endoscopy, Dunn et al7 present evidence that radiofrequency ablation (RFA) may relieve the symptoms of globus sensation or sore throat. GIPs in 10 symptomatic patients were treated. After a median of 2 RFA sessions, 8 of the 10 patients experienced complete endoscopic and histologic remission of their GIPs. Moreover, globus, sore throat, and cough improved significantly, with complete resolution of
Conclusion
Although pathogenic mechanisms are still not fully understood, there is growing evidence that GIPs can be associated with symptoms such as globus sensations and the persistent feeling of a sore throat. Owing to the ineffectiveness of nonendoscopic treatment approaches in contrast to the 80% success rate of endoscopic ablative therapies, we recommend that practitioners closely look for GIPs in symptomatic patients and, when they are detected, ablate the heterotopic mucosa with APC or RFA,
Disclosure
All authors disclosed no financial relationships relevant to this publication.
References (15)
- et al.
Erupted cysts in the cervical esophagus result in gastric inlet patches
Gastrointest Endosc
(2010) - et al.
Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations
Gastroenterology
(2009) - et al.
Incidence of heterotopic gastric mucosa in the upper oesophagus
Gut
(1991) - et al.
Intentional examination of esophagus by narrow-band imaging endoscopy increases detection rate of cervical inlet patch
Dis Esophagus
(2015) - et al.
Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients
Dis Esophagus
(2011) Some unusual developmental heterotopias
BMJ
(1968)Heteromorphosis (metaplasia) of the alimentary tract
J Pathol Bacteriol
(1923)
Cited by (15)
Prevalence of esophageal inlet patch and clinical characteristics of the patients
2019, Revista de Gastroenterologia de MexicoArgon Plasma Coagulation of Gastric Inlet Patches of the Cervical Esophagus Relieves Vocal and Respiratory Symptoms in Selected Patients
2023, Digestive Diseases and SciencesGastroesophageal reflux disease and salivary pepsin in patients with heterotopic gastric mucosa in the upper esophagus
2022, Diseases of the Esophagus