Purpose: Esophageal inlet patches are congenital anomalies of heterotopic gastric mucosa occurring in the proximal esophagus. They are infrequently seen, generally asymptomatic and typically do not warrant intervention. While rare complications may occur, there is only one documented case of bleeding from an inlet patch. We report an unusual case of melena resulting from an esophageal inlet patch. A 41-year-old woman with a past medical history of gastric bypass surgery was referred for evaluation of melena. She had a history of gastroesophageal reflux which was self-managed with intermittent antacids or over-the-counter lansoprazole. She denied nausea, vomiting, dysphagia, odynophagia, melena, and hematochezia. Her exam revealed stable vital signs, a benign abdomen with healed surgical scars and hemoccult positive stool. A colonoscopy revealed no abnormalities. An UGI with small bowel follow-through was normal. An EGD showed a 1-cm, irregular area of salmon-colored mucosa in the proximal esophagus with a central dark spot consistent with recent bleeding. No hemostatic intervention was required. Biopsies of the area revealed gastric mucosa with chronic inflammation. The gastric pouch, anastomosis, and small bowel mucosa was without abnormality. She was treated with omeprazole with resolution of her melena. There is limited available information in the literature on esophageal inlet patches. Endoscopy reveals salmon-colored mucosa distinct from the surrounding esophageal mucosa. Definitive diagnosis is made by histologic evaluation revealing gastric mucosa. Clinical manifestations are unusual, ranging from acid-related manifestations to dysplastic changes. The relationship with Helicobacter pylori is unclear. However, there has been only one previously reported case of bleeding associated with an inlet patch. This case illustrates the importance of careful endoscopic assessment and high level of suspicion in the appropriate clinical circumstances.