GASTROENTEROLOGY ARTICLE OF THE WEEK
September 29, 2005
von Rahden B, Stein H, Becker K, et al. Heterotopic gastric mucosa of the esophagus: Literature review and proposal of a clinicopathologic classification. Am J Gastroenterol 2004;99;543-51.
1. Endoscopic appearance of heterotopic gastric mucosa (HGM)
a. Usually located just below the cricopharyngeous muscle
b. Heaped margins indicates malignant transformation
c. Circumferential involvement implies Barrett’s rather than HGM
d. usual size is 0.2 x 0.3 cm to 3 x 4 cm
2. Clinical features of HGM
a. Acid production is not a feature of this lesion
b. Upper esophageal webs or rings could be due to the presence of HGM
c. HGM may be the pathophysiology underlying cases of Plummer-Vinson syndrome
d. Acid-related symptoms from HGM do not respond to PPI
e. Symptomatic clinical presentation includes dysphagia, odynophagia and supraesophageal reflux-related symptoms.
f. malignant transformation is exceedingly rare.
True or False
3. HGM is only found in the esophagus.
4. HGM histology usually revelas fundic-type gastric epithelium, esophagitis is usually present in the squamous mucosa adjacent to the patch.
5. Mucosa found in HGM is able to produce acid, potentially leading to strictures and webs.
6. H pylori colonization of HGM occurs only if H. pylori is present in the stomach.
7. Patients with HGM should undergo surveillance EGD to detect dysplasia