Proksimal Özofagusta Heterotopik Gastrik Mukoza Prevalansı ve Klinik ve Endoskopik Bulgular Arasındaki İlişki

Öz

Amaç

Heterotopik gastrik mukoza (HGMPE), genellikle proksimal özofagusta lokalize olan ektopik gastrik mukoza adasıdır. HGMPE' nin klinik önemi esas olarak asit üretimi ve neoplastik dönüşüm  kapasitesi ile ilişkilidir. Bu çalışmada HGMPE prevalansı ile klinik ve endoskopik bulgular arasındaki ilişkiyi araştırmayı amaçladık.

Yöntem

Aralık 2013 ile Şubat 2018 arasında Acıbadem Kayseri Hastanesi gastroenteroloji ünitesinde özofagogastroduodenoskopi yapılan 2091 kadın ve 2035 erkek toplam 4126 hasta retrospektif olarak tarandı. 54 kadın ve 68 erkekten oluşan toplam 122 HGMPE + hasta ile yaş ve cinsiyet açısından eşleştirilmiş 107 kadın ve 134 erkekten oluşan toplam 241 kişilik HGMPE - kontrol grubu çalışmaya dahil edildi.

Bulgular

Çalışmamızda HGMPE prevalansını % 2.96 olarak saptadık. Disfaji, hasta grubunda anlamlı olarak yüksek iken, kontrol grubunda abdominal ağrı daha fazlaydı. HGMPE + ve HGMPE – gruplar arasında reflü özofajit, duodenal ülser ve alt özofageal sfinkter eksikliği açısından istatistiksel olarak anlamlı bir fark bulunmadı.

Sonuç

Çalışmalar arasındaki çelişkilere rağmen, eğer endoskopist bu durumun farkında olursa  HGMPE'nin daha sık rastlanan bir endoskopik bulgu olabileceğini düşünüyoruz. Bu durumun klinik önemi ile ilgili tartışmalar devam etse de, artan sayıda neoplastik transformasyon HGMPE'nin önemini daha da artırmıştır.

Anahtar kelimeler: Heterotopik gastrik mukoza, Servikal inlet patch, Özofagus, Laringofaringeal reflü, Disfaji.

Anahtar Kelimeler

• Heterotopik gastrik mukoza,Servikal inlet patch

The Prevalence of Heterotopic Gastric Mucosa of the Proximal Esophagus and the Relationship Between Clinical and Endoscopic Findings

Öz

Purpose

In this study, we aimed to investigate the prevalence of HGMPE and the relationship between clinical and endoscopic findings.

 Patients and Methods

Between December 2013 and February 2018, a total of 4126 patients, 2091 women and 2035 men, who underwent esophagogastroduodenoscopy in the gastroenterology unit of Acıbadem Kayseri Hastanesi were retrospectively screened.

Totally, 122 patients, 54 women and 68 men found to have heterotopic gastric mucosa and a control group of age and sex matched 241 patients, 107 women and 134 men who do not have heterotopic gastric mucosa were included the study.

Results

We found the prevalence of HGMPE 2.96 % in our study. Dysphagia was significantly higher in the case group, whereas abdominal pain was higher in the control group.

Conclusion

Because of the controversies among the studies we think that HGMPE may be a frequent finding if the endoscopist be aware of this entity. Although the controversies remain regarding the clinical significance of this entity, increasing number of cases of neoplastic transformation has further increased the importance of HGMPE.

Anahtar Kelimeler

• Heterotopic gastric mucosa,Cervical inlet patch,Esophagus,Laryngopharyngeal reflux,Dysphagia

Kaynakça

1. Referans1 von Rahden BH, Stein HJ, Becker K et al. Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification. Am J Gastroenterol 2004; 99: 543–551.
2. Referans2 Chong VH. Heterotopic gastric mucosal patch of the proximal esophagus. Gastrointestinal Endoscopy 2011; 125–148
3. Referans3 Borhan-Manesh F, Farnum JB. Incidence of heterotopic gastric mucosa in the upper oesophagus. Gut 1991; 32: 968–972
4. Referans4 Orizio P, Villanacci V, Bassotti G et al. Heterotopic gastric mucosa in the cystic duct. Int. J. Surg. Pathol 2011; 19: 364–365
5. Referans5 Mann NS, Mann SK, Rachut E. Heterotopic gastric tissue in the duodenal bulb. J. Clin. Gastroenterol 2000; 30: 303–306
6. Referans6 Jarry J, Rault A, Sa Cuhna A et al. Acute recurrent pancreatitis by heterotopic fundic mucosa at the ampulla of vater. Pancreas 2009; 38: 351–353
7. Referans7 Rifat Mannan AA, Kahvic M, Bharadwaj S etal. Gastric heterotopia of the anus: report of two rare cases and review of the literature. Indian J. Pathol. Microbiol 2008; 51: 240–241
8. Referans8 Avidan B, Sonnenberg A, Chejfec G et al. Is there a link between cervical inlet patch and Barrett’s esophagus? Gastrointest Endosc 2001; 53: 717–721

9. Referans9 Meining A, Bajbouj M. Erupted cysts in the cervical esophagus result in gastric inlet patches. Gastrointest Endosc 2010; 72: 603–605
10. Referans10 Takeji H, Ueno J, Nishitani H. Ectopic gastric mucosa in the upper esophagus: prevalence and radiologic findings. Am. J. Roentgenol 1995; 164: 901–904
11. Referans11 Rector LE, Connerly ML. Aberrant mucosa in the esophagus in infants and in children. Arch. Pathol 1941; 31: 285–294
12. Referans12 Truong LD, Stroehlein JR, McKechnie JC. Gastric heterotopia of the proximal esophagus: a report of four cases detected by endoscopy and review of literature. Am. J. Gastroenterol 1986; 81: 1162–1166
13. Referans13 Schroeder WW, Myer III CM, Schechter GL. Ectopic gastric mucosa in the cervical esophagus. Laryngoscope 1987; 97: 131–135
14. Referans14 Taylor AL. The epithelial heterotopias of the alimentary tract. J. Pathol 1927; 30: 415–449
15. Referans15 Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol 2013; 193): 331-338
16. Referans16 Akbayir N, Alkim C, Erdem L et al. Heterotopic gastric mucosa in the cervical esophagus (inlet patch): endoscopic prevalence, histological and clinical characteristics. J Gastroenterol Hepatol 2004; 19: 891–896
17. Referans17 Lauwers GY, Scott GV, Vauthey JN. Adenocarcinoma of the upper esophagus arising in cervical ectopic gastric mucosa: rare evidence of malignant potential of so-called “inlet patch” Dig. Dis. Sci 1998; 43: 901–907
18. Referans18 Gutierrez O, Akamatsu T, Cardona H et al. Helicobacter pylori and hetertopic gastric mucosa in the upper esophagus (the inlet patch) Am J Gastroenterol 2003; 98: 1266–1270
19. Referans19 Alagozlu H, Simsek Z, Unal S et al. Is there an association between Helicobacter pylori in the inlet patch and globus sensation? World J. Gastroenterol 2010; 16: 42–47
20. Referans20 Ward EM, Achem SR. Gastric heterotopia in the proximal esophagus complicated by stricture. Gastrointest Endosc 2003; 57: 131–133
21. Referans21 Buse PE, Zuckerman GR, Balfe DM. Cervical esophageal web associated with a patch of heterotopic gastric mucosa. Abdom Imaging 1993; 18: 227–228
22. Referans22 Bataller R, Bordas JM, Ordi J et al. Upper gastrointestinal bleeding: a complication of “inlet patch mucosa” in the upper esophagus. Endoscopy 1995; 27: 282
23. Referans23 Katsanos KH, Christodoulou DK, Kamina S et al. Diagnosis and endoscopic treatment of esophago-bronchial fistula due to gastric heterotopy. World J. Gastrointest Endosc 2010; 2: 138–142
24. Referans24 García AO, Mazzadi SA, Raffo L et al. Heterotopic gastric mucosa in the upper esophagus: report of a case with a fistula. Dis Esophagus 2002; 15: 262–265
25. Referans25 Righini CA, Faure C, Karkas A et al. Spontaneous perforation in the upper oesophagus resulting from ulcer in heterotopic gastric mucosa. Rev. Laryngol Otol Rhinol (Bord) 2007; 128: 197–200
26. Referans26 Sahin G, Adas G, Koc B et al. Is Cervical Inlet Patch Important Clinical Problem? Int J Biomed Sci 2014; 10(2): 129-35
27. Referans27 Neumann WL, Luján GM, Genta RM. Gastric heterotopia in the proximal oesophagus (“inlet patch”): Association with adenocarcinomas arising in Barrett mucosa. Dig Liver Dis 2012; 44: 292–296
28. Referans28 Chong VH, Jalihal A. Heterotopic gastric mucosal patch of the esophagus is associated with higher prevalence of laryngopharyngeal reflux symptoms. Eur Arch Otorhinolaryngol 2010; 267: 1793–1799.
29. Referans29 Weickert U, Wolf A, Schröder C 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; 24: 63–68
30. Referans30 Jacobs E, Dehou MF. Heterotopic gastric mucosa in the upper esophagus: a prospective study of 33 cases and review of literature. Endoscopy 1997; 29: 710–715
31. Referans31 Yüksel I, Usküdar O, Köklü S et al. Inlet patch: associations with endoscopic findings in the upper gastrointestinal system. Scand J Gastroenterol 2008; 43: 910–914
32. Referans32 Poyrazoglu OK, Bahcecioglu IH, Dagli AF et al. Heterotopic gastric mucosa (inlet patch): endoscopic prevalence, histopathological, demographical and clinical characteristics. Int J Clin Pract 2009; 63: 287–291
33. Referans33 Baudet JS, Alarcón-Fernández O, Sánchez Del Río A et al. Heterotopic gastric mucosa: a significant clinical entity. Scand J Gastroenterol 2006; 41:1398–1404