Yusuf AYDEMİR, Hayriye HIZARCIOĞLU GÜLŞEN, Evrim YILMAZ, Zeren BARIS, Zuhal AKCOREN, Dıclehan ORHAN, Hulya DEMIR

Çocuklarda Inlet Patch’in Klinik Önemi

Inlet patch (IP) heterotopik olarak proksimal özofagusta yerleşen gastrik mukoza alanıdır. Her ne kadar çoğunluğu belirtisiz olsa da, sindirim ve solunum belirtileriyle ilişkili olabilir. Bu çalışmayla çocuklarda IP’nin prevelansı, endoskopik ve histopatolojik bulguları, klinik önemi ve izlem sonuçlarının değerlendirilmesi amaçlanmıştır. Histopatolojik olarak kanıtlanmış IP’i olan 0-18 yaş aralığındaki hastalar çalışmaya alınmıştır. Demografik veriler, klinik belirtiler, endoskopik ve histopatolojik bulgular, uygulanan tedaviler ve izlem sonuçları arşivden kaydedildi. Geriye dönük incelenen özofagogastroduodenoskopi kayıtlarından 11/2674 (0.41%) IP’li hasta saptandı. Hastaların 8’inde tek iken, bir hastada 2, iki hastada ise 3 adet IP vardı. Histopatolojik değerlendirme sonucu 9 hastada fundik and 2 hastada ise antral tip gastrik mukoza olduğu görüldü. Hematemezi olan bir hasta ve disfajisi olan bir hastada IP mukozasının hiperemik ve H. pylori ile kolonize olduğu belirlendi. Yanma, disfaji, hematemez ve ses kısıklığı olan 4 farklı hastada IP, saptanan tek patolojik endoskopik bulguydu. Hastalardan 8’inde proton pompa inhibitörü tedavisi ile belirtiler tamamen kaybolmuştu. Helicobacter pylori eradikasyonu enfekte olan tüm hastalarda sağlandı. Ses kısıklığı olan bir hasta dışında başka solunum belirtisi olan yoktu. İzlemde perforasyon, darlık veya displazi gelişimi gibi bir komplikasyon izlenmedi. Inlet patch çocuklarda sindirim belirtilerine eşlik edebilir veya sorumlu olabilir. Tedavisinde PPI etkilidir. Endoskopist, hastanın dispeptik semptomlarına rağmen normal özofagogastroduodenoskopi bulguları varsa IP açısından özellikle dikkatli olmalıdır.

Anahtar Kelimeler:

Özofagus, özofagogastroduodenoskopi, Helicobacter pylori, heterotopic gastrik mukoza, inlet patch

Clinical Significance of Inlet Patch in Children

Inlet patch (IP) is an area of heterotopic gastric mucosa located in proximal esophagus. Although the majority of IP are asymptomatic, they may be associated with digestive and respiratory symptoms. We aimed to assess prevalence, endoscopic and histopathological findings, clinical significance and outcome of inlet patch in children.The patients with histopathologically proven IP and aged between 0-18 years old were enrolled. Demographic data, clinical symptoms, endoscopic and histopathological findings, treatment modality, and outcomes were collected from medical records. Retrospective review of 2674 esophagogastroduodenoscopy records revealed 11 (0.41%) children. Eight of our patients had a solitary patch whereas others had two (n=1) or three (n=2). Histopathological evaluation revealed that 9 patients had fundic and 2 patients had antral type gastric mucosa. One patient with hematemesis and other with dysphagia had hyperemic patchy areas of which were colonized by H. pylori. Inlet patch was the only pathological endoscopic finding in 4 patients with a single symptom each: heartburn, dysphagia, hematemesis and hoarseness. Symptoms were completely resolved with PPI treatment in 8 children. Helicobacter pylori eradication was achieved in all infected patients. No respiratory symptom was recorded except hoarseness in one patient. No complications like perforation, stenosis or dysplasia that might be related to IP were recorded at follow-up. We suggest that an IP may accompany or may be responsible for digestive symptoms in children and PPI treatment is effective. Endoscopist should be aware of this condition, especially if the patient has dyspeptic symptoms and normal endoscopic findings.

Keywords:

Esophagus, esophagogastroduodenoscopy, Helicobacter pylori, heterotopic gastric mucosa, inlet patch,

PDF

___

1. Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol. 2013;19:331-8.
2. Maconi G, Pace F, Vago L, et al. Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch). Eur J Gastroenterol Hepatol. 2000;12:745-9.
3. 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;71:316-7.
4. Georges A, Coopman S, Rebeuh J, et al. Inlet patch: clinical presentation and outcome in children. J Pediatr Gastroenterol Nutr. 2011;52:419-23.
5. Karnak I, Senocak ME, Akçören Z, et al. Ectopic gastric mucosa causing dysphagia due to strictures in a boy. Eur J Pediatr Surg. 1999;9:413-5.
6. Macha S, Reddy S, Rabah R, et al. Inlet patch: heterotopic gastric mucosa another contributor to supraesophageal symptoms? J Pediatr. 2005;147:379-82.
7. di Palmo E, Cazzato S, Tursini S, et al. A rare association of inlet patch with laryngospasm: a report of two children and literature review. Pediatr Pulmonol 2011;46:934-8.
8. Devereaux CE, Devereaux RG. Heterotopic gastric mucosa of the rectum with a review of the literature. J Clin Gastroenterol. 1994;19:41-5.
9. Kalman PG, Stone RM, Phillips MJ. Heterotopic gastric tissue of the bile duct. Surgery. 1981;89:384-6.
10. Lamont N, Winthrop AL, Cole FM, et al. Heterotopic gastric mucosa in the gallbladder: a cause of chronic abdominal pain in a child. J Pediatr Surg. 1991;26:1293-5.
11. Shim YT, Kim SY. Heterotopic gastric mucosa and pancreatic tissue in the skin of the abdominal wall. J Pediatr Surg. 1992;27:1539-40.
12. Wolff M, Rankow RM. Heterotopic gastric epithelium in the head and neck region. Ann Plast Surg. 1980;4:53-64.
13. Xeropotamos N, Skopelitou AS, Batsis C, et al. Heterotopic gastric mucosa together with intestinal metaplasia and moderate dysplasia in the gall bladder: report of two clinically unusual cases with literature review. Gut. 2001;48:719-23.
14. Rusu R, Ishaq S, Wong T, et al. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol. 2018;9:214-20.
15. von Rahden BH, Stein HJ, 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.
16. Avidan B, Sonnenberg A, Chejfec G, et al. Is there a link between cervical inlet patch and Barrett’s esophagus? Gastrointest Endosc. 2001; 53:717-21.
17. Meining A, Bajbouj M. Erupted cysts in the cervical esophagus result in gastric inlet patches. Gastrointest Endosc. 2010;72: 603-5.
18. Emery JL, Haddadin AJ. Gastric-type epithelium in the upper esophageal pouch in children with tracheoesophageal fistula. J Pediatr Surg. 1971;6:449-53.
19. Variend S, Howat AJ. Upper oesophageal gastric heterotopia: a prospective necropsy study in children. J Clin Pathol. 1988;41:742-5.
20. Azar C, Jamali F, Tamim H, et al. Prevalence of Endoscopically Identified Heterotopic Gastric Mucosa in the Proximal Esophagus Endoscopist Dependent? J Clin Gastroenterol. 2007;41:468-71.
21. Galan AR, Katzka DA, Castell DO. Acid secretion from an esophageal inlet patch demonstrated by ambulatory pH monitoring. Gastroenterology. 1998;115:1574-6.
22. Weickert U, Wolf A, Schröder C, et al. Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients. Dis Esophagus. 2011;24:63-8.
23. Gutierrez O, Akamatsu T, Cardona H, et al. Helicobacter pylori and hetertopic gastric mucosa in the upper esophagus (the inlet patch). Am J Gastroenterol. 2003; 98:1266-70.
24. von Rahden BH, Stein HJ, 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.
25. Bataller R, Bordas JM, Ordi J, et al. Upper gastrointestinal bleeding: a complication of “inlet patch mucosa” in the upper esophagus. Endoscopy. 1995; 27:282.
26. Righini CA, Faure C, Karkas A, et al. Spontaneous perforation in the upper oesophagus resulting from ulcer in heterotopic gastric mucosa. Rev Laryngol Otol Rhinol 2007;128:197-200.
27. Daher P, Francis E, Raffoul L, et al. Ectopic gastric mucosa in the cervical esophagus presenting as a recurrent neck abscess: a case report. J Pediatr Surg. 2010; 45: e15-e17.
28. Rana SS, Panda N, Sinha SK, et al. Heterotopic gastric mucosa in the upper esophagus manifesting as a polypoidal mass causing dysphagia. Gastrointest Endosc. 2006;63:185-7.
29. Akbayir N, Alkim C, Erdem L, et al. Heterotopic gastric mucosa in the cervical esophagus (inlet patch): endoscopic prevalence, histological and clinical characteristics. J Gastroenterol Hepatol. 2004;19:891-6.
30. Poyrazoglu OK, Bahcecioglu IH, Dagli AF, et al. Heterotopic gastric mucosa (inlet patch): endoscopic prevalence, histopathological, demographical and clinical characteristics. Int J Clin Pract. 2009;63:287-91.
31. Bajbouj M, Becker V, Eckel F, et al. Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations. Gastroenterology. 2009;137:440-4.
32. Alberty JB, Chanis R, Khoshoo V. Symptomatic gastric inlet patches in children treated with argon plasma coagulation: a case series. J Interv Gastroenterol. 2012;2:91-3.