Abstract
Ectopic gastric mucosa (EGM) is considered to be a congenital condition. Rare cases of adenocarcinoma have been described. There are no data justifying regular biopsies or follow-up. Cyclooxygenase-2 (COX-2) is a protein involved in gastrointestinal tumor development by inhibiting apoptosis and regulating angiogenesis. The aim of this prospective study was to evaluate COX-2 expression in EGM and compare it with normal tissue and Barrett's esophagus. We evaluated 1327 patients. Biopsies were taken from the inlet patch for histological evaluation and from the gastric antrum to assess Helicobacter pylori infection. Biopsies taken from normal esophageal, gastric antrum and body mucosa and Barrett's esophagus were retrieved from a tissue bank. EGM biopsies were evaluated with respect to type of epithelium, presence of H. pylori, and inflammation. COX-2 was detected by immunohistochemistry using the avidin-biotin complex. EGM islets were found in 14 patients (1.1%). Histological examination revealed fundic type epithelium in 58.3% of cases, H. pylori was present in 50% and chronic inflammation in 66.7%. Expression of COX-2 was negative in normal distal esophagus, normal gastric antrum and normal gastric body specimens (10 each). In contrast, EGM presented over-expression of COX-2 in 41.7% of cases and Barrett's esophagus in 90% of cases (P = 0.04 and 0.03, respectively). COX-2 immunoexpression in EGM was not related to gender, age, epithelium type, presence of inflammation or intestinal metaplasia, H. pylori infection, or any endoscopic finding. Our results demonstrate up-regulation of COX-2 in EGM, suggesting a possible malignant potential of this so-called harmless mucosa.
Highlights
Ectopic gastric mucosa (EGM) is an asymptomatic anomaly found in the cervical esophagus, designated inlet patch
A biopsy from the gastric antrum was taken in these patients to determine H. pylori infection by the rapid urease test [20]
Heterotopic gastric mucosa is defined as a salmon pink colored patch localized in the upper esophagus and designated as inlet patch
Summary
Ectopic gastric mucosa (EGM) is an asymptomatic anomaly found in the cervical esophagus, designated inlet patch. The patch is characterized by reddish or salmon-red mucosa with a velvety appearance. It presents as either a single or multiple patches localized just below the upper esophageal sphincter. The patch can be lined with fundic or gastric body type glands [1,2,3]. The prevalence of EGM ranges from 0.1 to 4.9% in most series, reaching 10% in a prospective study [1,2,3]. The presence of Helicobacter pylori has been reported in 20 to 56.5% of cases [1,2,3,4]
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