Brunner gland heterotopia presenting as gastric antral polyps

Abstract

Gastric polyps were once thought to be rare but are now discovered quite commonly, probably as a result of fiberoptic endoscopy and refinement of radiologic techniques. A recent series reported that out of 55,000 endoscopic examinations, 1127 patients were found to have gastric polyps.' Necropsy series vary in the reported incidence of gastric polyps probably reflecting a usually benign nature and clinically silent course. This paper presents a rare case of Brunner gland polyps (heterotopias) which produced symptoms of intermittent gastric outlet obstruction because of size and location. CASE REPORT A 42-year-old white woman was referred for cardiology evaluation. She complained of midepigastric pain radiating into the chest for 2 weeks. The pain was characterized as sharp and was immediately followed by nausea and vomiting, which produced minimal reliefofthe pain. Antacids and milk failed to relieve the pain with any consistency. The patient denied use of salicylates, alcohol beverages, or cigarettes but acknowledged heavy consumption of coffee. On physical examination, the patient was noted to be moderately obese, but otherwise physical findings were unremarkable. Guaiac testing of a stool sample was negative for occult blood. Laboratory data included normal blood counts, serum electrolytes, and SMA-12. The chest x-ray and electrocardiogram were interpreted as normal. Because of the symptoms, not typical of angina or other cardiac pain, gastroenterology consultation was obtained. The initial impression was that the patient might have peptic esophagitis. Upper gastrointestinal and barium enema examinations and oral cholecystography were normal. Esophageal motility studies were normal. The Bernstein esophageal acid perfusion test was positive. Esophagoscopy showed normal esophageal mucosa with an unremarkable gastroesophageal junction. The mucosa of the distal esophagus was biopsied and reported subsequently as normal. The stomach contained a large quantity of chyme with a food-coated bezoar situated in the distal antrum. Both the patient and her nurses confirmed that she had been fasting jJ