Mrs Williams, 50 year old women had an endoscopy performed for symptoms of chronic epigastric pain and bloating. Endoscopy showed
What is the diagnosis?
Inlet patch. This is an incidental finding in this case
What is an inlet patch?
Inlet patch is an island of heterotopic gastric mucosa typically located at or just below the upper oesophageal sphincter.
Endoscopically it appears as salmon pink coloured mucosa surrounded by normal pearl white coloured squamous oesophageal epithelium.
It is considered a congenital anomaly, a remnant of gastric mucosa which is left behind during the descent of the stomach in embryologic development.
In addition, there are several studies that demonstrate a correlation between the presence of cervical inlet patch and Barrett’s oesophagus suggesting a possible aetiology link.
How common is inlet patch?
The incidence of inlet patch is probably between 1-4%. However, they are often missed if not carefully looked for as the scope is removed. Another reason for the low rate of diagnosis is due to decreased clinical importance and the lack of information available in the textbooks. In addition, as there is little chance of malignant transformation, this lesion is frequently overlooked, or given low priority.
What are the clinical manifestations of inlet patch?
Most patients are completely asymptomatic.
Rarely, however, acid production by these inlet patches causes ulceration, strictures, and dysphagia.
Approximately 25 cases of adenocarcinoma related to inlet patch have been reported.
What are the next steps after an endoscopic diagnosis of inlet patch?
No further action is warranted. It is an incidental finding and mostly asymptomatic.
Image courtesy of www.gastrointestinalatlas.com
