CC March 2016 Heterotopic Gastric Mucosa

echoecho's version from 2016-05-29 22:39


Question Answer
The term "inlet patch" refers to what?heterotropic gastric mucosa (HGM) of the proximal or cervical esophagus
HGM (heterotrophic gastric mucosa) originates from?incomplete embryonic epithelialization of the proximal esophagus
How does HGM manifests as what?small oval or round patches comprised of parietal (oxyntic)type mucosa or antral mucosa
The prevalence of HGM at endoscopy ranges from ___ - ____% but may be underestimated, as these small patches can be easily missed due to their size and close proximity with the upper esophageal sphincter?0.1; 10
Though historically only found at autopsy, the clinical significance of the inlet patch warrants what?a closer look to understand their impact
Clinically, patients with proximal esophageal HGM are often asymptomatic, and it is incidentally detected during endoscopy for other complaints. Because of their gastric origin, HGM tissue can secrete ______ ____ in response to typical gastric stimuli (vagal simulation through acetylcholine or histamine/gastrin release)?hydrochloride acid
As a result of the HCL production and the proximal esophageal location of HGM, symptoms may range from?dysphagia, odynophagia and hoarseness or coughing, to structural changes such as esophageal strictures, webs or esophagotracheal fistula
In very rare instances (only 26 total published cases in a 2010 research study), HGM can undergo transformation into?adenocarcinoma
This usually occurs in a stepwise fashion, list these?normal ---> symptomatic ----> structural changes ---> dysplasia ---> invasive adenocarcinoma
Given the rarity of malignant trasnformation, especially in the absence of significant clinic symptoms, is routine biopsy and CT looking for metastases warranted?no
List the classifications of HGM?1) HGM I (asymptomatic) 2) HGM II (symptomatic without morphologic changes like dysphagia, hoarseness) 3) HGM III (symptomatic with morphologic changes like web, strictures) 4) HGM IV (intraepithelial neoplasia) 5) HGM V (invasive adenocarcinoma), (a) or (b)
In a small number of dedicated studies, _________ was detected on biopsy of HGM (though always concurrently with detection in the stomach)?H. pylori
Are there specific inflammatory changes noted with HP-positive HGM, and the treatment regimen does not change because of infection at dual sites?no
HP-positive HGM has been theorized as a possible mechanisms for ___ to ____ transmission of H. pylori between individuals, though this was not the primary endpoint examined in any study?oral; oral
*** List the management strategies for HGM?1) HGM I (no intervention or routine follow-up required) 2) HGM II (treatment with PPI to control symptoms 3) HGM III (treatment with PPIs, endoscopic therapy (dilation) and biopsy for malignancy) 4) HGM IV (close surveillance, consideration for APC (argon plasma coagulation - ablation can be considered for II or III if not responsive to medical treatment) or resection 5) HGM V (resection consistent with current oncologic guidelines
*** SUMMARY = HGM may be asymptomatic or may cause what?dysphagia, odynophagia and hoarseness or coughing or even structural changes such as esophageal strictures, webs or esophagotracheal fistula
*** SUMMARY = In rare instances, it can undergo transformation to what?adenocarcinoma
*** SUMMARY = Management depends on what?1) presence or absence of symptoms 2) morophologic changes or neoplastic changes