Research Article

Heterotopic Gastric Mucosa of the Proximal Esophagus: An Under recognized Entity

Sarhani Asmae*, Paupard Thierry, Ghani Sara, Salihoun Mouna and Kabbaj Nawal

Published: 05 February, 2020 | Volume 4 - Issue 1 | Pages: 001-005

Heterotopic gastric mucosa (HGM) is an islet of gastric mucosa within the esophageal mucosa. These lesions can sit throughout the digestive tract and rarely in the upper third of the esophagus. The pathophysiology of HGM remains poorly understood.

Our study aims to estimate the prevalence of HGM, clinical signs, endoscopic, microscopic aspects and different epidemiological factors associated.

All patients from a single endoscopy center with HGM of the upper third of the esophagus were included over a 5-month evaluation period. All lesions seen in endoscopy were confirmed by histological analysis.

The prevalence was 1.3% with a clear male predominance. 80% of patients were symptomatic and received medical treatment, clinical evolution was good. No case of dysplasia was identified and no complication was observed.

Due to insufficient data in the evolutionary literature, the management of HGM remains debated and could resemble that of Barett’s esophagus for monitoring and therapeutic management, particularly in the event of symptoms or dysplasia.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001014 Cite this Article Read Full Article PDF


Heterotopic gastric mucosa; Proximal esophagus


  1. Poyrazoglu OK, Bahcecioglu IH, Dagli AF, Ataseven H, Celebi S, et al. Heterotopic gastric mucosa (inlet patch): endoscopic prevalence, histopathological, demographical and clinical characteristics. Int J Clin Pract. 2009; 63: 287-291. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17535303
  2. Komori, Shuji, Shinji O, Yoshihiro T, Takao T, et al. A Case of Esophageal Adenocarcinoma Arising from the Ectopic Gastric Mucosa in the Thoracic Esophagus. Rare Tumors. 2010; 12-15. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21139950
  3. Yoshida T, Shimizu Y, Kato M. Image of the month. Use of magnifying endoscopy to identify early esophageal adenocarcinoma in ectopic gastric mucosa of the cervical esophagus. Clin Gastroenterol Hepatol. 2010; 8: e91-e93. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20347051
  4. Akanuma N, Hoshino I, Akutsu Y, Shuto K, Shiratori T, et al. Primary esophageal adenocarcinoma arising from heterotopic gastric mucosa: report of a case. Surg Today. 2013; 43: 446-451. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22706784
  5. Terada T. Heterotopic gastric mucosa of the gastrointestinal tract: a histopathologic study of 158 cases. Pathol Res Pract. 2011; 207: 148-150. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21242038
  6. Chen YR, Wu MM, Nan Q, Duan LP, Miao YL, et al. Heterotopic gastric mucosa in the upper and middle esophagus: 126 cases of gastroscope and clinical characteristics. Hepatogastroenterology. 2012; 59: 1123-1125. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22580663
  7. Neumann WL, Lujan 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. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22222950
  8. Alagozlu H, Simsek Z, Unal S, Cindoruk M, Dumlu S, et al. Is there an association between Helicobacter pylori in the inlet patch and globus sensation? World J Gastroenterol. 2010; 16: 42-47. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20039447
  9. Carrie A. Adenocarcinoma of the upper end of the oesophagus arising from ectopic gastric epithelium. Br J Surg. 1950; 37: 474. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15414304
  10. Meining A, Bajbouj M, Preeg M, Reichenberger J, Kassem AM, et al. Argon plasma ablation of gastric inlet patches in the cervical esophagus may alleviate globus sensation: a pilot trial. Endoscopy. 2006; 38: 566-570. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16802267
  11. Latos W. Clinical evaluation of twenty cases of heterotopic gastric mucosa of upper esophagus during five-year observation, using gastroscopy in combination with histopathological and microbiological analysis of biopsies. Contemp Oncol. 2013; 17: 171-175. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23788986
  12. Von Rahden, et al. Heterotopic gastric mucosa of the esophagus literature-review and proposal of a clinicopathologic classification. Am J Gastroenterol. 2004; 99: 543-551. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15056100
  13. Mohammed IA, Streutker CJ, Ridell RH. Utilization of cytokeratins 7 and 20 does not differentiate between Barett’s esophagus and gastric cardiac intestinal metaplasia. Mod Pathol. 2002; 15: 611-616.
  14. Chatelain D, de Lajarte T. Adenocarcinoma of the upper esophagus arising in heterotopic gastric mucosa: Common pathogenesis with Barett’s adenocarcinoma? Virchows Arch. 2002; 441: 406-411.
  15. Klaase JM, Lemaire LC, Rauws EA. Heterotopic gastric mucosa of the cervical esophagus: A case of high-grade dysplasia treated with argon plasma coagulationand a case of adenocarcinoma. Gastrointest Endosc. 2001; 53: 101-104.
  16. López CA. Prevalencia y características clínicas de pacientes con parche de mucosa gástrica ectópica en esófago Revista de Gastroenterología de México. 2019; 84: 442-448. PubMed:
  17. Tang P, McKinley MJ, Sporrer M, Kahn E. Inlet patch: prevalence, histologic type, and association with esophagitis, Barrett esophagus, and antritis. Arch Pathol Lab Med. 2004; 128: 444-447. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15043461
  18. Borhan MF, Farnum JB. Incidence of heterotopic gastric mucosa in the upper oesophagus. Gut. 1991; 32: 968-972. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1916499
  19. Akbayir N, Alkim C, Erdem L, Sokmen HM, Sungun A, et al. Heterotopic gastric mucosa in the cervical esophagus (inlet patch): endoscopic prevalence, histological and clinical characteristics. J Gastroenterol Hepatol. 2004; 19: 891-896. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15242492
  20. Bajbouj M, Becker V, Eckel F, Miehlke S, Pech O, et al. Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations. Gastroenterology 2009; 137: 440-444. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19410576
  21. Dunn JM, Sui G, Anggiansah A, et al. Radiofrequency ablation of symptomatic cervical inlet patch using a through-the-scope device: a pilot study. Gastrointest Endosc. 2016; 84: 1022-1026. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27373671
  22. Rusu R. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterology. 2017; 0: 1-7. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30046427
  23. Al-Mammari S, Selvarajah U, East JE. Narrow band imaging facilitates detection of inlet patches in the cervical oesophagus. Dig Liver Dis. 2014; 46: 716-719. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24890619
  24. Cheng CL, Lin CH, Liu NJ. Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images. World J Gastroenterol. 2014; 20: 242-249. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24415878
  25. Yu Fang. Prevalence, histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients. World J Gastroenterol. 2014; 20: 17588-17594. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25516674
  26. Ohara M. Incidence of heteroptopic gastric mucosa in the upper esophagus in first time narrow banding image endoscopy of consecutive 900 patients. Gastrointest Endosc. 2010; 71: 316-317.
  27. Azar C, Jamali F, Tamim H, Abdul-Baki H, Soweid A. Prevalence of endoscopically identified heterotopic gastric mucosa in the proximal esophagus: endoscopist dependent? J Clin Gastroenterol. 2007; 41: 468-471. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17450028
  28. Gutierrez O, Akamatsu T, Cardona H, Graham DY, El-Zimaity HM. Helicobacter pylori and heterotopic gastric mucosa in the upper esophagus (the inlet patch). Am J Gastroenterol. 2003; 98: 1266-1270.
  29. 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. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9427488
  30. Galan AR, Katzka DA, Castell DO. Acid secretion from an esophageal inlet patch demonstrated by ambulatory pH monitoring. Gastroenterology. 1998; 115: 1574-1576. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9834287
  31. Meining A, Bajbouj M. Gastric Inlet Patches in The cervical esophagus: what they are, what they cause and how they can be treated. Gastrointestinal Endoscopy. 2016; 84: 1027-1029. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27855791


Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?