Heterotopic Gastric Mucosal Patch of the Proximal Esophagus

Heterotopic gastric mucosa (HGM) is abnormally placed gastric mucosa outside of the stomach and can be found almost anywhere within the gastrointestinal tract (von Rahden et al., 2004). HGM is most commonly found in the esophagus. The most widely known HGM in the gastrointestinal tract is in the Meckel’s diverticulum. However, HGM is also found in the other part of the gastrointestinal tract including the tongue (Melato & Ferlito, 1975; Ortiz, 1982; Surana, 1993), duodenum (Kibria et al., 2009; Mann, 2000), gallbladder (Hayama et al., 2010; Popkharitoy et al., 2008), jejunum (Boybeyi et al., 2008; Nowak & Deppisch, 1998), ileum (Chan et al., 1999; Erez et al., 1991), rectum (Garmendia et al., 2007; Vieth et al., 2005) and anus (Steele et al., 2004). Interestingly, HGM of the umbilicus, a part of remnant alimentary tract has also been report (Heo et al., 2010). HGM patch (HGMP) of the proximal esophagus, also referred to as cervical inlet patch (CIP) is typically found in the proximal esophagus. It can also be found in the other part of the esophagus (Borhan-Manesh & Franum, 1991; Katsanos et al., 2010). On endoscopy, HGMP/CIP is clearly distinct from the esophageal squamous mucosa. HGMP/CIP is widely considered to be congenital in nature. However, it has also been proposed to be an acquired condition (Avidan et al., 2001; Meining & Baubouj, 2010). In clinical practice, HGMP/CIP is an under-recognized condition. The incidence reported in the literature varies with lower estimates in the earlier endoscopic studies (von Rahden et al., 2004). Later studies reported higher incidence (Ohara, 2010). The highest incidence was reported in an autopsy study (von Rahden et al., 2004). Use of newer endoscopic modalities has been reported to increase the pick up rates of HGMP/CIP. HGMP/CIP is largely asymptomatic and is incidental findings during endoscopy evaluations for other gastrointestinal complaints. Commonly reported symptoms are those symptoms complex referred to as extra-esophageal manifestations of gastro-esophagael reflux disorders. Other common upper aero-digestive disorders have also been linked to HGMP/CIP. Despite the benign nature of HGMP/CIP, serious and important complications have been reported (von Rahden et al., 2004). Furthermore, associations with higher frequencies of laryngopharyngeal malignancies have also been reported (Basseri et al., 2009). A clinico-pathologic classification has been proposed which categorized HGMP/CIP into five distinct groups based on clinical, endoscopic and histological findings (von Rahden et