Evaluation of children with heterotopic gastric mucosal patch in the proximal esophagus

Yıl 2022, Cilt: 21 Sayı: 1, 28 - 34, 26.04.2022

Sevinç Garip

https://doi.org/10.17941/agd.1095935

Öz

Background and Aims: The inlet patch is an island of ectopic gastric mucosa located proximal to the esophagus. It was first described by Schmidt in 1805. Different theories have been proposed about its formation. The heterotopic gastric mucosa is macroscopically oval, velvety, and pinkish salmon in color. It is distinctly separated from the normal mucosa and has different sizes. It rarely surrounds the esophagus. It can be seen on the back or side walls of the esophagus as a single piece or multiple pieces. It is mostly asymptomatic and can present with supraesophageal, esophageal, respiratory, and gastrointestinal symptoms. During esophagogastroduodenoscopy, it can be easily overlooked when the esophagus passed quickly. Therefore, its incidence and prevalence are low. The frequency of detection of the inlet patch by esophagogastroduodenoscopy varies between 0.1% and 10% depending on the reasons it was performed. Moreover, no comprehensive studies have been conducted in pediatric patients. Therefore, children aged 18 years who were found to have heterotopic gastric mucosa by esophagogastroduodenoscopy, performed for different reasons, were included the study. In this study, we aimed to determine the prevalence of heterotopic gastric mucosa and study its demographic, clinical, macroscopic, and histological features for presenting them in the light of the literature. Materials and Methods: The study included pediatric patients aged <18 years who were diagnosed with heterotopic gastric mucosa by esophagogastroduodenoscopy between October 2017 and December 2020. Patients’ clinical data were retrospectively reviewed. Results: In this study, heterotopic gastric mucosa was detected in 30 (1.2%) out of 2,500 pediatric patients that underwent esophagogastroduodenoscopy. Half of the patients were male, and the mean age was 13.4 years. The most common complaint was abdominal pain in 75%. Other accompanying complaints were dysphagia in 45.8%, hemoptysis in 12.5%, and heartburn and regurgitation in 8.3%. Laboratory evaluations revealed vitamin B12 deficiency and iron deficiency anemia in 37.5% and 33.3% of the patients, respectively. In the esophagus, the lesions ranged from 5 to 17 cm, 5–50 mm in diameter (most commonly 5–10 mm: 53.4%), single and multiple (most commonly single in 79.1%), and with salmon red or pink velvety appearance. In esophagogastroduodenoscopy, nodular gastritis and peptic ulcers were detected in 66.6% and 8.3% of the patients, respectively. Histopathologically, Helicobacter pylori gastritis was detected in 45.8% of the patients. Cases were reviewed according to subtypes: 83.3% had type 2 heterotopic gastric mucosa, 16.6% had type 3, and 4% had type 4. No cases of types 1 and 5 were found. At diagnosis, one patient had stricture and ulcer and three patients had hemoptysis as complications. Patients were followed up for 1 year, and none of them needed argon laser or additional therapies. Conclusions: Heterotopic gastric mucosa is rare in children; however, it should not be ignored because of the risk of metaplasia. In patients with suggestive symptoms, the upper esophagus should be examined slowly and carefully, and the area just below the upper esophageal sphincter should be evaluated cautiously. To obtain a specific diagnosis, esophagogastroduodenoscopy must be performed by experienced endoscopists. As many causes of heterotopic gastric mucosa in children are not understood, further studies are needed.

Anahtar Kelimeler

Child, heterotopic gastric mucosa, inlet patch, esophagogastroduodenoscopy

Proksimal özofagusta heterotopik gastrik mukozal yama saptanan çocukların değerlendirilmesi

Öz

Giriş ve Amaç: İlk olarak 1805 tarihinde Schmidt tarafından tanımlanan “inlet patch” (heterotopik gastrik mukoza) özofagus proksimaline yerleşmiş ektopik mide mukoza adasıdır. Farklı oluşum teorileri vardır. Makroskopik olarak oval, pembemsi somon renginde kadifemsi görünümde normal mukozadan keskin sınırla ayrılan, farklı boyutlarda olan, nadiren özofagusu çevreleyen heterotopik gastrik mukoza arka ya da yan duvarda, tek veya multiple parçalar halinde görülebilir. Çoğunlukla asemptomatik olup, supraözofageal, özofageal, solunum ve gastrointestinal semptomlarla kendini gösterebilir. Özofagogastroduodenoskopi sırasında hızla özofagus girilip çıkıldığı için kolaylıkla gözden kaçabilir, bu nedenle insidans ve prevalansı düşüktür. Çeşitli nedenlere bağlı olarak özofagogastroduodenoskopide sıklığı %0.1-10 arasında değişmektedir. Pediatrik grupta yapılmış geniş kapsamlı çalışma olmadığı için 18 yaş altı farklı nedenlerle özofagogastroduodenoskopi yapılarak heterotopik gastrik mukoza saptanan çocukların demografik ve klinik özellikleri, prevalansı, makroskopik ve histolojik özellikleri belirlenerek literatür eşliğinde sunmak amaçlanmıştır. Gereç ve Yöntem: Ekim 2017 ve Aralık 2020 tarihleri arasında 18 yaş altında özofagogastroduodenoskopi yapılarak heterotopik gastrik mukoza tanısı konan çocuk hastalar çalışmaya dahil edildi. Bulgular: Çalışmada özofagogastroduodenoskopi yapılan 2500 çocuk hastanın 30’unda (%1.2) heterotopik gastrik mukoza saptandı. Hastaların yarısı erkek, ortama yaş 13.4 yıl, en sık başvuru şikayeti %75 ile karın ağrısıydı. Eşlik eden diğer şikayetler ise; %45.8 disfaji, %12.5 hemoptizi, %8.3 pirozis ve %8.3 regürjitasyondu. Laboratuvar incelemelerinde %37.5 vitamin B12 eksikliği, %33.3 demir eksikliği anemisi vardı. Lezyonlar özofagusta 5-17. cm arasında, 5 - 50 mm çapında (en sık 5 - 10 mm, %53.4), tek ve multiple sayıda (en sık 1 adet, %79.1), somon kırmızısı pembe kadifemsi görünümdeydi. Özofagogastroduodesnokopide %66.6 hastada nodüler gastrit, %8.3 peptik ülser; histopatolojide %45.8 Helicobacter pylori gastriti saptandı. Tiplerine göre değerlendirildiğinde tip 2 heterotopik gastrik mukoza %83.3, tip 3 heterotopik gastrik mukoza %16.6, tip 4 heterotopik gastrik mukoza %4’tü. Tip 1 ve tip 5 saptanmadı. Komplikasyon olarak tanı anında 1 hastada darlıkla beraber ülser, 3 hastada hemoptizi şeklinde kanama vardı. Hastaların bir yıllık takip sürelerinde medikal tedavi dışında argon lazer ve ek tedavi ihtiyacı olmadı. Sonuç: Çocuklarda nadir görülse de heterotopik gastrik mukoza metaplazi riski olması nedeniyle göz ardı edilmemelidir. Semptomu olan hastalarda üst özofagustan yavaş ve dikkatli geçilmeli, üst özofagus sfinkterinin hemen altı mutlaka değerlendirilmelidir. İşlemin deneyimli bir endoskopist tarafından yapılması tanısal açıdan çok önemlidir. Çocuklarda heterotopik gastrik mukozanın anlaşılmayan birçok kısmını netleştirmek için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

Çocuk, heterotopik gastrik mukoza, inlet patch, özofagogastroduodenoskopi

Kaynakça

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