Esophageal inlet patch

Esophageal inlet patch (EIP), also known as cervical inlet patch or heterotopic gastric mucosa of the esophagus, is a congenital condition characterized by the presence of gastric mucosa in the upper esophagus. This condition is of clinical interest due to its association with various esophageal symptoms and complications.

Overview

An esophageal inlet patch is a patch of stomach-like mucosa located in the upper part of the esophagus. It is thought to arise from embryonic remnants of gastric mucosa that persist in the esophagus after development. These patches can vary in size and are typically found just below the upper esophageal sphincter.

Symptoms and Diagnosis

Many individuals with an esophageal inlet patch are asymptomatic and the condition is often discovered incidentally during endoscopy for other reasons. However, some patients may experience symptoms such as dysphagia (difficulty swallowing), odynophagia (painful swallowing), sore throat, cough, and acid reflux symptoms.

Diagnosis of an esophageal inlet patch is primarily made through endoscopy, where the characteristic appearance of the gastric mucosa in the esophagus can be visualized. Biopsy and histological examination of the patch can confirm the presence of gastric mucosa.

Management

The management of esophageal inlet patch largely depends on the symptoms. Asymptomatic patients may not require treatment. For symptomatic patients, treatment options include proton pump inhibitors (PPIs) to reduce acid production and alleviate symptoms related to acid reflux. In rare cases where severe complications arise, such as ulceration or significant narrowing of the esophagus, surgical intervention may be considered.

Complications

Complications from esophageal inlet patches are rare but can include ulceration, bleeding, and the development of strictures. There is also a very low risk of malignant transformation, although this is exceedingly rare.

Conclusion

Esophageal inlet patches are congenital anomalies that can lead to a variety of esophageal symptoms. While many individuals remain asymptomatic, recognition and appropriate management of symptoms can significantly improve the quality of life for those affected. Ongoing research into the implications of esophageal inlet patches and their management continues to evolve, providing better outcomes for patients.