Esophageal Polyp Arising from a Gastric Inlet Patch Causing Dysphagia

Abstract

Purpose: Heterotopic gastric mucosa is usually an aymptomatic finding. We present a 58-year-old male who was admitted for nausea, vomiting and coffee ground emesis. He also noted intermittent solid food dysphagia, heartburn and epigastric pain. His history was positive for diabetes, end stage renal disease (ESRD) on hemodialysis, hypertension and chronic alcohol use. Physical exam was positive for epigastric tenderness, mild dehydration and hypotension which stabilized with medical resuscitation. Endoscopy revealed two salmon colored patches of columnar appearing epithelium in the proximal esophagus suggestive of gastric inlet patches. There was a large, 1 cm, semipedunculated esophageal polyp arising from one of these patches. In addition, there was extensive erosive esophagitis seen in the distal and middle esophagus. The gastric mucosa appeared erythematous. Biopsies from the polyp confirmed it to consist of gastric cardia type mucosa with hyperplastic foveolar epithelium and inflammatory cells with no evidence of squamous epithelium. The salmon colored mucosal patches were positive for gastric cardia type of epithelium with evidence of ulcerative esophagitis. The inflamed esophageal mucosa showed changes of reflux esophagitis. Gastric mucosal biopsy was suggestive of non specific reactive gastropathy. The patient was started on high dose proton pump inhibitor therapy and other resuscitative measures were instituted. Plan was to repeat endoscopy and an EUS after 6 weeks of treatment with PPI. However, after resolution of his symptoms, the patient deferred further invasive work-up. Esophageal polyps are a rare occurrence and may be of diverse histopathologic types. The class of hyperplastic esophageal polyps is usually found in relation to GERD, at the GE junction and is histologically characterized by proliferation of hyperplastic gastric-type foveolar epithelium, hyperplastic squamous epithelium, or an admixture of the two linings with variable inflammatory infiltrate. This case illustrates a very rare occurrence of an esophageal polyp arising from gastric inlet patch and causing symptomatic dysphagia.