Ectopic (heterotopic) gastric mucosa in the upper esophagus (HGMUE), frequently referred to as an “inlet patch” in the literature, is visible directly under the upper oesophageal sphincter during a slow retraction of an endoscope with a variable frequency ranging from 0.1 to 10%. It seems that the clinical significance of this anomaly, most frequently asymptomatic, remains underestimated.
By presenting 2 cases of dysplasia within the macroscopically typical HGMUE in this paper we would like to bring up the important problem of potential neoplastic transformation of this congenital change.
Case study
1. An endoscopic examination carried out on a 65 year old female patient, complaining of a recurrence of heavy heartburn, discomfort in the epigastrum and other ailments of a dyspeptic character, revealed a slightly collapsed smooth area of reddened and shiny mucosa sized app. 20 × 20 mm, with well-marked borders, suspected to be HGMUE. Results of histopathological examination of the specimen collected in the upper oesophagus disclosed a focus of low grade dysplasia in the heterotopic gastric mucosa.
2. The second patient, also a 65 year old female, was treated for esophagitis erosiva (Los Angeles). A supervisory endoscopic examination carried out after 2 weeks of intensive conservative treatment, introduced with lansoprazole in a dose 2 × 30 mg, revealed almost completely healed erosions. However, it also revealed two well-defined, shiny, smooth and reddened areas of mucosa, different comparing to their surroundings, just below the upper oesophageal sphincter during a slow retraction of the endoscope. Results of the histopathological examination of the bifocal change of the mucosa revealed two ectopies. One of them contained a focus of low grade dysplasia.
Conclusion: Despite the fact, that most HGMUE lesions remain asymptomatic anomalies, the two above-presented cases of patients with dysplasia in heterotopic gastric mucosa indicate the possibility of neoplastic transformation.