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Prevalence of Endoscopically Identified Heterotopic Gastric Mucosa in the Proximal Esophagus

Endoscopist Dependent?

Azar, Cecilio, MD*; Jamali, Faek, MD; Tamim, Hala, PhD; Abdul-Baki, Heitham, MD*; Soweid, Assaad, MD, FACG*

Journal of Clinical Gastroenterology: May-June 2007 - Volume 41 - Issue 5 - p 468-471
doi: 10.1097/01.mcg.0000225519.59030.8d
Alimentary Tract: Clinical Research

Goals The aim of this study is to determine the prevalence of heterotopic gastric mucosa in the proximal esophagus (HGMPE) and whether thorough endoscopic search may influence such prevalence.

Background Heterotopic gastric mucosa in the esophagus (sometimes known as inlet patch) refers to a discrete area of gastric mucosa, with a spherical or ellipsoid configuration, that is typically located in the proximal esophagus. The prevalence of endoscopically diagnosed HGMPE varies from 0.1% to 10%. Endoscopic detection may be difficult as HGMPE is often located at or just below the upper esophageal sphincter. It might be associated with severe complications such as bleeding, perforation, fistula, and stricture formation, in addition to the development of adenocarcinoma.

Study During a 2-year period, 455 consecutive patients with various gastrointestinal complaints underwent esophagogastroduodenoscopy by a single endoscopist (group 1). This endoscopist paid special attention to detecting HGMPE by thoroughly examining the proximal esophagus upon withdrawal of the endoscope. During the same period of time, endoscopy reports of 472 patients who underwent esophagogastroduodenoscopy in the same hospital by 3 other endoscopists were retrospectively reviewed (group 2). These endoscopists were aware of the existence of the HGMPE and reported that the presence of HGMPE would be included as an endoscopic finding in their reports.

Results In the first group, HGMPE was identified in 12 out of 455 patients (2.6%). Whereas in the second group, only 2 out of 472 patients (0.4%) had reports identifying HGMPE (P<0.01).

Conclusions Endoscopic detection of HGMPE is influenced by the endoscopist's thorough search of this entity, and thus, more time devoted to such a search may lead to higher detection rates.

Departments of *Internal Medicine


Epidemiology and Population Health, American University of Beirut, Lebanon

Reprints: Assaad Soweid, MD, FACG, Internal Medicine Department, Gastroenterology Division, American University of Beirut Medical Center, PO Box 11-0236, Beirut 1107 2020, Lebanon (e-mail:

Received for publication April 8, 2006; accepted May 3, 2006

© 2007 Lippincott Williams & Wilkins, Inc.