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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2020; 74(3): 250–255. doi:10.14735/amgh2020250.

An unusual case of upper type dysphagia

Róbert Linter1, Josef Kubát2, Vojtěch Mezera3, Petr Vyhnálek1

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Inlet patch (IP) is an area of heterotopic gastric mucosa outside of its normal location. It probably originates during the 11th week of embryogenesis as a disruption of mucosal layers. Inlet patch can be located anywhere in the gastrointestinal tract, from oral cavity all the way to the anus. The most frequent location of IP is the proximal esophagus. The prevalence of heterotopic gastric mucosa ranges from 0.9 to 15%. The presence of IP is mostly asymptomatic. However, some patients can experience hoarseness, cough, feeling of an obstactle in the throat or a sore throat. The pathogenesis arises from hypersecretion of gastric acid by parietal cells within the IP resulting into inflammatory infiltrate, ulceration, chronic strictures and even occasionaly into a malignant transformation. The dia­gnostics of this anomaly is based on meticulously performed endoscopy with a specific focus on proximal esophagus as well as by means of virtual chromoendoscopy. In our paper, we present a case report of a young male examined for chronic dysphagia and respiratory complaints. The initial ENT examination already revealed the cause of patient’s symptoms in the upper esophagus. During gastroscopy, there was a smooth stenosis of unusual, salmon-like color, which we were able to pass with the endoscope. Histology revealed a heterotopic gastric mucosa resembling gastric cardia. Considering his chronic dysphagia and recent aspiration pneumonia, a dilatation was required. We also excluded malignant transformation. The dilatation was with a complete remission of patient’s symptoms. Repeated histology identified signs of intestinal metaplasia without dysplasia, so we let the patient for observation without intervention.

Key words: heterotopic gastric mucosa – dysphagia – inlet patch – proton pump inhibitors – benign esophageal stricture – peptic ulcer


heterotopická žaludeční sliznice, dysphagia, inlet patch, proton pump inhibitors, benigní stenóza jícnu, peptický vřed

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