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Heterotopic gastric mucosa in the cervical oesophagus (inlet patch) and globus pharyngeus – an under-recognised association

Published online by Cambridge University Press:  14 December 2006

A Alaani
Affiliation:
Department of ENT, North Staffordshire University Hospital, Stoke on Trent, Bradford, UK
P Jassar
Affiliation:
Department of ENT, Hull Royal Infirmary, Hull, UK
A T Warfield
Affiliation:
Department of Cellular Pathology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
D R Gouldesbrough
Affiliation:
Department of Histopathology, Bradford, UK
I Smith
Affiliation:
Department of ENT, Bradford Royal Infirmary, Bradford, UK.

Abstract

Globus pharyngeus is a symptom commonly encountered in ENT practice. The usual complaint is that of the sensation of a ball or lump in the throat generally unaccompanied by dysphagia. This sensation is often more pronounced when taking an ‘empty swallow’. The precise mechanism of this remains enigmatic in many cases. Irritant factors such as gastroesophageal reflux, postnasal drip and excessive throat clearing may be contributory factors as may be stress and psychological influences. Although gastric type mucosa occupying the cervical oesophagus has been long recognised, mainly in the specialised gastrointestinal literature, there appears to be more limited awareness of the condition in ENT practice and the clinical significance of such heterotopia is not well established. We present five recent cases of globus pharyngeus encountered in our ENT practice in which rigid pharyngoesophagoscopy and biopsy revealed heterotopic gastric mucosa within the postcricoid and cervical oesophagus constituting a so-called gastric ‘inlet patch’. One case re-presented with invasive adenocarcinoma within a short time. Herein we compare and contrast inlet patch with columnar lined oesophagus, discuss the potential clinical significance of inlet patch and comment upon further management of the condition.

Type
Main Articles
Copyright
2006 JLO (1984) Limited

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