Complications of ectopic gastric mucosal structure

This is an automatically translated article.

Posted by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital
The detection of an ectopic gastric mucosal network or ring suggests the pathogenesis of an acid-induced lesion. Invasion of H. pylori may exacerbate complications of ectopic gastric mucosa.

1. Ectopic gastric mucosa and Barrett's esophagus

Conflicting results regarding the association between ectopic gastric mucosal structures and Barrett's esophagus indicate that their interaction is largely speculative. However, a genetic link between Barrett's esophagus and ectopic gastric mucosal structures can be disputed due to their immunohistochemical similarities, including expression of the same mucin core protein. and their cytokeratin patterns.
In contrast, Feurle et al. evaluation of neuroendocrine immunohistochemical staining patterns of ectopic gastric mucosa and Barrett's esophagus revealed that they are distinct parts of an anterior differential spectrum. , with ectopic gastric mucosal structures representing the embryonic stage of gastric mucosa, while cells from Barrett's esophagus represent more primitive and pluripotent cells.

2. H. pylori and ectopic gastric mucosa

There is also controversy surrounding the suspected association of H. pylori with ectopic gastric mucosal structures and reflux esophagitis. Some authors hypothesized that reflux may be required for H. pylori to reside in ectopic gastric mucosal structures. However, there are differences in the literature in conclusions regarding the correlation between H. Pylori and the incidence of gastroesophageal reflux disease (GERD).
Other studies have hypothesized that dyspepsia, including the sensation of choking, is caused by chronic inflammation produced by H. pylori in the gastric mucosa of ectopic gastric mucosal structures in the esophagus. .. A case report suggests that eradication of H. pylori can improve extragastric symptoms associated with ectopic gastric mucosal structures and lead to beneficial histopathological changes , which suggests that H. pylori and H. pylori eradication therapy may have different effects in patients with ectopic gastric mucosal structures.
However, this report was limited by the fact that the patient had both H. pylori bacteria in the stomach and esophagus. Therefore, it cannot be determined whether the improvement in swallowing sensation and heartburn is due solely to eradication of H. pylori or whether proton pump inhibitors (PPIs) are commonly included in treatment.

3. Complications of ectopic gastric mucosal structure

In isolated cases, complications have been reported including bleeding, ulceration, stricture, perforation and fistula of the trachea and subcutaneous abscess. In a small series of cases, the discovery of an ectopic gastric mucosal network or ring suggested the pathogenesis of an acid-induced lesion. Importantly, H. pylori colonization can exacerbate these complications.

3.1 Ectopic gastric mucosal structure and functional dyspepsia Injuries to the cervical esophagus should be recognized and addressed, particularly in the absence of other upper tract lesions that could explain the patient complaints, these steps should be taken before diagnosing functional dyspepsia or non-erosive reflux.
Patients who have been diagnosed with a potentially functional gastrointestinal disorder may be frustrated by the failure to find a cause for their condition. This situation can lead to a vicious cycle of anxiety. Furthermore, simply explaining to patients that harmless ectopic gastric mucosal structures in their esophagus may be causing their symptoms may help better control the condition through the placebo effect. .
Psychological discomfort is common and the pathophysiology of persistent functional dyspepsia is not well understood. However, a persistent choking sensation can also result from pressure on the upper esophageal sphincter resulting from an ectopic gastric mucosal structure that is easily irritated or from a reflex esophageal sphincter contraction. due to a respiratory protective mechanism, possibly related to reflux.
3.2 Ectopic gastric mucosal structure and esophageal cancer Another related question is whether ectopic gastric mucosal structure is involved in the pathophysiology of esophageal cancer? Considering the number of studies reporting an ectopic gastric mucosal structure as a harmless mucosal region that can be overlooked, one might think that the limited number of cases with both esophageal and Ectopic gastric mucosal structures are incidental.
On the other hand, recent case reports of adenocarcinoma describe ectopic gastric mucosal structures as small and flat lesions and rather conspicuous compared with ectopic gastric mucosal structures. healthy place. Therefore, should endoscopists feel guilty for missing this type of lesion or for not taking biopsies as often? The answer to this question depends on how much the lesion is related to the patient's symptoms and if the lesion affects the patient's outcome.

Whether ectopic gastric mucosal structures increase the risk of esophageal carcinoma is controversial. Acid secretion is also a suspected cause of malignancy, but there is a difference between the prevalence of ectopic gastric mucosal structures associated with symptomatic acid and rare cases of malignancy. reported.

4. Treatment and screening

There are no standard guidelines for the management of ectopic gastric mucosal structures other than the clinical pathology classification system of Von Rahden et al., which aims to regulate management but is based on limited literature. regime. A thorough collaboration between disciplines (otolaryngologists, pulmonologists, endocrinologists, gastroenterologists and psychiatrists) should be developed to increase the efficiency of the diagnosis of gastric mucosal structures. Ectopic thickening in patients with unexplained extraesophageal symptoms.
Symptoms and their response to treatment may depend on many factors such as the type of ectopic gastric mucosal structure, H. pylori colonization and ectopic gastric mucosal structural factors extraesophageal, but further studies are needed to draw firm conclusions.
As there is no proven link between histopathology and clinical symptoms of ectopic gastric mucosal structures, symptomatic patients should be treated and reevaluated endoscopically when Suspected other complications of gastric mucosal foreign body. In selected cases, such as patients at high risk for cancer or symptomatic patients, the elderly, or smokers, ectopic gastric mucosal structures should be evaluated systematically and Thoroughly described with endoscopic diagnosis and the patient should be considered for surveillance. Von Rahnen's classification used in conjunction with the NBI description may be included in the endoscopic report to improve awareness of any potential progression of the lesion at subsequent evaluation.

5. Conclusion

The ectopic gastric mucosal structural entity is subject to being overlooked, unexplored, and a source of curiosity. Its natural history and clinical significance are still poorly defined due to the limited number of ambiguous studies in the literature. Each person should examine the cervical oesophagus regularly and carefully to develop the differential diagnosis, especially in patients with initial functional gastrointestinal disorders and in patients with upper dysphagia, chronic cough without clear cause or persistent stinging sensation. The malignancy of ectopic gastric mucosal structures and its association with other entities such as Barrett's esophagus remains controversial.
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