Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Mucosa
 The
 Esophagogastric  Junction
 Barrett's
 Esophagus

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OESO©2015
 
Volume: Barrett's Esophagus
Chapter: Diagnosis
 

What is the frequency of occurrence of inlet patch of gastric mucosa in the proximal esophagus in Barrett's patients?

M. Schapiro (Los Angeles)

The "inlet patch" is the presence of an isolated collection(s) or "island(s)" of heterotopic gastric type mucosa located most frequently in the cervical esophagus. Though the etiology is not completely understood it likely arises from incomplete embryological replacement of the columnar mucosa by squamous epithelium. The islands are not felt to arise from metaplastic conversion as occurs with true Barrett's mucosa associated with gastroesophageal reflux disease.

Three publications [1-3] have placed the incidence of "inlet patches" at 4% to 10% throughout the esophagus. Though prospective studies have been carried out, the true incidence is subject to dispute as the area immediately below the upper esophageal sphincter is difficult to evaluate and an incidence as high as 70% has been reported.

The reported incidence for location is 50% for the cervical esophagus though most observers agree that due to the difficulty in evaluating this area the incidence is probably under reported.

Though the patches may be seen in association with stenosis, webs, esophagitis and H. pylori infection, the relationship to these conditions is unknown and the lesion is not felt to be symptom producing. Of importance is the question of relationship to the development of dysplasia and subsequent adenocarcinoma. There is consensus that this lesion is not premalignant as is felt to occur with true Barrett's mucosa. Nevertheless, malignancy and severe dysplasia does infrequently occur. This consideration raises the issue of follow-up surveillance for the "inlet" patch once the diagnosis is made. There does not seem to be enough evidence to support either an initial screening or a follow-up cost effective surveillance program.

The endoscopist should be on the lookout for the "inlet patch" on traversing the upper esophageal sphincter. When found, initial biopsy may be in order to rule out true Barrett's type epithelium with or without dysplasia. Decisions regarding follow-up would depend on the biopsy findings.

References

1. Jacobs E, Dehou MF. Heterotopic gastric mucosa in the upper esophagus: a prospective study of 33 cases and review of the literature. Endoscopy 1997;29:710-715.

2. Jabbari M, Goresky CA, Lough J, et al. The inlet patch: heterotopic gastric mucosa in the upper esophagus. Gastroenterology 1985;89:352-356.

3. Borhan-Manesh F, Farnum JB. Incidence of heterotopic gastric mucosa in the upper esophagus. Gut 1991;32:968-972.


Publication date: August 2003 OESO©2015