Esophageal and gastric mucosal heterotopia

Esophageal gastric mucosal ectopy is a congenital disease and its incidence is very low compared to other stomach diseases. There are many mucous membranes from the stomach to the esophagus, and all of these mucous membranes may develop esophageal and gastric mucosal ectopia. The symptoms of esophageal and gastric mucosal ectopia are not very obvious and are discovered by chance. Most of them will not cause harm to the body. What needs to be noted is that it is easy to be combined with Helicobacter pylori infection.

Causes

The cause of the disease has not yet been fully elucidated, but it is generally believed to be related to congenital developmental abnormalities. During embryogenesis, the columnar epithelium covering the surface of the esophagus is replaced by stratified squamous epithelium. If this replacement process is incomplete, embryonic gastric mucosa may remain in the esophagus, resulting in esophageal gastric mucosal ectopia. Since patients often have no obvious symptoms clinically, the disease is often discovered accidentally during gastroscopy. In recent years, with the widespread use of electronic gastroscopy and the improvement of inspection and treatment techniques, the number of cases of this disease has increased, and the endoscopic detection rate reported domestically and internationally is 4.9%~10%.

Disease hazards

Esophageal and gastric mucosal ectopy is a congenital abnormality that generally does not cause obvious harm. However, patients often have concurrent diseases of gastric acid hypersecretion, and the prevalence of Barrett's esophagus is significantly increased. Therefore, esophageal gastric mucosal ectopy may be a dual-cause disease, caused by underlying congenital embryonic developmental abnormalities and acquired gastric acid reflux stimulation. Esophageal ectopic gastric mucosal carcinoma is extremely rare, but it is easily complicated by Helicobacter pylori infection.

Differential diagnosis

The clinical manifestations of patients with esophageal and gastric mucosal heteroplasia are mostly nonspecific, and most of them are only discovered accidentally during gastroscopy, but sometimes acid-related symptoms such as discomfort behind the sternum and dysphagia may also occur. Endoscopic examination is the main means of diagnosing this disease, but it is often easily missed when the gastroscope is inserted due to its high location. The typical lesion is an oval or round orange-red mucosa with clear boundaries in the upper esophagus, which is clearly demarcated from the surrounding esophageal mucosa. In a few cases, polyp-like or raised lesions may occur. Pathological biopsy can reveal gastric fundus glands.

Disease treatment

Patients with esophageal and gastric mucosal heterotopia who have no clinical symptoms may not receive special treatment for the time being. However, since the heterotopic gastric mucosa has the function of acid secretion, it may cause esophageal ulcers, bleeding, or complications of gastroesophageal reflux disease, so acid suppression treatment may be performed. Most patients can achieve symptom relief with conventional doses. Endoscopic treatment can be performed if acid suppression therapy is ineffective, symptoms are frequent, the patient has a heavy psychological burden, or cancer is suspected, including endoscopic laser, argon knife, and high-frequency electrocautery. Endoscopic mucosal resection can be performed when necessary.