Inlet Patch Stricture: A Rare Case Report

Abstract

Purpose: Inlet patch is common but inlet patch stricture in the upper esophagus is usually a rare finding that can cause dysphagia. With very limited case reports in the literature, the aim of our study is to present a case of a patient with dysphagia secondary to inlet patch stricture. Methods: Case report: A 72-year-old male presents with the history of intermittent dysphagia especially for solids for 14 years with endoscopic finding of Schatzki's ring at lower esophagus. He also had esophageal dilatation in the past. Patient continues to have recurrent dysphagia that occurs usually 5-6 times a year. For the past two weeks, the frequency of his symptoms has increased to 2-3 episodes per week. This difficulty in swallowing is located at suprasternal notch and patient also had unintentional 10 lb weight loss. Esophagogastroduodenoscopy showed the presence of stricture at 20cm from the incisura. Esophagus biopsy confirmed the presence of gastric type epithelium consistent with inlet patch stricture. There was no Schatzki's ring at gastroesophageal (GE) junction. GE junction was consistent with 1 cm pink mucosa suggestive of Barrett's esophagus. Patient was then treated with proton pump inhibitors and advised to take soft diet. The diet modification helped to resolve the patient's symptoms and he did not need esophageal dilatation again. Results: An inlet patch is described as Heterotopic Gastric Mucosa (HGM) usually located in the proximal esophagus below the cricopharyngeus. The endoscopy reveals the patch to appear as velvety orange-red or salmon colored, which is well demarcated from the pearly gray squamous esophageal mucosa. The esophagus is usually lined with the stratified columnar epithelium, which is replaced by gastric type epithelium in the inlet patch. Conclusion: Inlet patch is an anomaly of the cervical esophagus. The gastric mucosa is uniformly fundic type, which consists of parietal cells, and is seen more commonly compared to transitional cell type, which is a mixture of both fundic or an antral pattern. Inlet patch stricture is a rare finding that can present with symptoms and morphological changes due to the damaging effect of acid produced by parietal cells in fundic type of HGM. Our patient has Class II HGM and was treated with soft diet and acid suppression.