Clinical Significance of Inlet Patch in Children

Öz

Inlet patch (IP) is an area of heterotopic gastric mucosa located in proximal esophagus. Although the majority of IP are asymptomatic, they may be associated with digestive and respiratory symptoms. We aimed to assess prevalence, endoscopic and histopathological findings, clinical significance and outcome of inlet patch in children.The patients with histopathologically proven IP and aged between 0-18 years old were enrolled. Demographic data, clinical symptoms, endoscopic and histopathological findings, treatment modality, and outcomes were collected from medical records. Retrospective review of 2674 esophagogastroduodenoscopy records revealed 11 (0.41%) children. Eight of our patients had a solitary patch whereas others had two (n=1) or three (n=2). Histopathological evaluation revealed that 9 patients had fundic and 2 patients had antral type gastric mucosa. One patient with hematemesis and other with dysphagia had hyperemic patchy areas of which were colonized by H. pylori. Inlet patch was the only pathological endoscopic finding in 4 patients with a single symptom each: heartburn, dysphagia, hematemesis and hoarseness. Symptoms were completely resolved with PPI treatment in 8 children. Helicobacter pylori eradication was achieved in all infected patients. No respiratory symptom was recorded except hoarseness in one patient. No complications like perforation, stenosis or dysplasia that might be related to IP were recorded at follow-up. We suggest that an IP may accompany or may be responsible for digestive symptoms in children and PPI treatment is effective. Endoscopist should be aware of this condition, especially if the patient has dyspeptic symptoms and normal endoscopic findings.

Anahtar Kelimeler

• Esophagus
• esophagogastroduodenoscopy
• Helicobacter pylori
• heterotopic gastric mucosa
• inlet patch

Çocuklarda Inlet Patch’in Klinik Önemi

Öz

Inlet patch (IP) heterotopik olarak proksimal özofagusta yerleşen gastrik mukoza alanıdır. Her ne kadar çoğunluğu belirtisiz olsa da, sindirim ve solunum belirtileriyle ilişkili olabilir. Bu çalışmayla çocuklarda IP’nin prevelansı, endoskopik ve histopatolojik bulguları, klinik önemi ve izlem sonuçlarının değerlendirilmesi amaçlanmıştır. Histopatolojik olarak kanıtlanmış IP’i olan 0-18 yaş aralığındaki hastalar çalışmaya alınmıştır. Demografik veriler, klinik belirtiler, endoskopik ve histopatolojik bulgular, uygulanan tedaviler ve izlem sonuçları arşivden kaydedildi. Geriye dönük incelenen özofagogastroduodenoskopi kayıtlarından 11/2674 (0.41%) IP’li hasta saptandı. Hastaların 8’inde tek iken, bir hastada 2, iki hastada ise 3 adet IP vardı. Histopatolojik değerlendirme sonucu 9 hastada fundik and 2 hastada ise antral tip gastrik mukoza olduğu görüldü. Hematemezi olan bir hasta ve disfajisi olan bir hastada IP mukozasının hiperemik ve H. pylori ile kolonize olduğu belirlendi. Yanma, disfaji, hematemez ve ses kısıklığı olan 4 farklı hastada IP, saptanan tek patolojik endoskopik bulguydu. Hastalardan 8’inde proton pompa inhibitörü tedavisi ile belirtiler tamamen kaybolmuştu. Helicobacter pylori eradikasyonu enfekte olan tüm hastalarda sağlandı. Ses kısıklığı olan bir hasta dışında başka solunum belirtisi olan yoktu. İzlemde perforasyon, darlık veya displazi gelişimi gibi bir komplikasyon izlenmedi. Inlet patch çocuklarda sindirim belirtilerine eşlik edebilir veya sorumlu olabilir. Tedavisinde PPI etkilidir. Endoskopist, hastanın dispeptik semptomlarına rağmen normal özofagogastroduodenoskopi bulguları varsa IP açısından özellikle dikkatli olmalıdır.

Anahtar Kelimeler

• Özofagus
• özofagogastroduodenoskopi
• Helicobacter pylori
• heterotopic gastrik mukoza
• inlet patch

Kaynakça

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