Heterotopic Gastric Tissue of the Duodenal Bulb: A Report of 2 Cases

Abstract

Purpose: We present 2 cases of Heterotopic Gastric Tissue of the Duodenal Bulb (HGTDB). Case 1: A 71-year-old female patient complained of diarrhea with spicy and greasy food for 20 years. Her medical history is significant for hypertension. Physical examinations were within normal limits. The initial diagnosis of irritable bowel syndrome was made. The upper GI endoscopy was done and was found to have erythematous atrophic gastric mucosa, few sessile fundal gastric polyp, and large frond-like villous fungating mass in the duodenal bulb. Narrow band imaging showed vascularity suggestive of adenomatous tissue. The pathology report of the duodenal bulb mass revealed heterotopic gastric body tissue without evidence of dysplasia. Colonoscopy showed 3 sessile polyps, pathology revealed mixed hyperplastic and adenomatous polyp. Case 2: A 49-year-old male patient presented with chronic anemia. Colonoscopy was done a year ago showed hyperplastic polyp. Physical examinations were within normal limits. Stool occult blood was positive. Upper endoscopy was performed this time and showed mild gastritis and circumferential nodular mucosa in the duodenal bulb. Pathology from the duodenal bulb revealed heterotopic gastric body tissue without evidence of dysplasia or malignancy. The prevalence of HGTDB is reported to be 0.5-2%. The most common site for heterotopic gastric mucosa (HGM) is the upper esophagus, often just below the upper esophageal sphincter. Another common site is the duodenal bulb. In this site, heterotopic tissue often forms a small nodule or polyp. However, it is usually an incidental finding. Histologically, HGTDB is characterized by the presence of well organized and well differentiated gastric glands complete with chief and parietal cells. Gastrin-producing cells have been seen in ectopic gastric mucosa. Heterotopic gastric mucosa in the duodenal bulb is the uncommon condition which can be confused for a mass. Obtaining a correct diagnosis is important because this condition does not require surgical management.