Gastric metaplasia of the proximal esophagus associated with esophageal adenocarcinoma and Barrett's esophagus: What is the connection? Inlet patch revisited

Background/Aim: The inlet patch is an area of heterotopic gastric mucosa fo und in the proximal esophagus at the level of the upper esophageal sphincte r. Limited data are available regarding this form of gastric metaplasia and its incidence, significance, and possible association with other esophagea l diseases. We report our observations of such gastric metaplasias in patie nts with esophageal adenocarcinoma or Barrett's esophagus and high-grade dy splasia. Methods: All patients having Barrett's esophagus and adenocarcinom a referred for photodynamic therapy were included in this study. The patien ts were prospectively evaluated endoscopically for the presence of gastric metaplasia of the proximal esophagus (salmon-colored area of a least 5 mm i n dia meter with cardia-type gastric metaplasia on biopsy). Results: A tota l of 36 patients were included in this study: 11 patients with dysplastic B arrett's esophagus (8 males, mean age 79 years) and 25 adenocarcinoma patie nts (18 males, mean age 71 years). At endoscopy prior to photodynamic thera py, 11 patients (31%; 8 adenocarcinoma, 3 dysplastic Barrett's esophagus) w ere noted to have an area of gastric mucosa in the proximal esophagus. In e ach patient, there was at least 5 cm of normal squamous mucosa between gast ric metaplasia and distal esophageal pathology. Conclusions: in this select ed group of patients with high-grade dysplastic Barrett's esophagus or aden ocarcinoma referred for photodynamic therapy, gastric metaplasia of the pro ximal esophagus was found in nearly one third. Prospective studies are unde r way to test more widely for this association and to determine whether thi s is a marker of disease severity and the result of similar pathogenetic me chanisms, Copyright (C) 2000 S. Karger AG, Basel.