Ectopic Gastric Tissue in Upper Esophagus – An Unusual Presentation

Ectopic gastric mucosa is well known in pediatric population presented as Meckel’s diverticula. We present an unusual case of ectopic gastric mucosa in upper esophagus

12-year-old boy with dysphagia for last 2 months without history of caustic ingestion or NSAID medicines use. Retrosternal pain during eating was noted which aggravated with time leading to severe dysphagia. Esophagogastroduodenoscopy showed large upper esophageal ulcer just below esophageal entrance. Rest of esophagus, stomach and duodenum were found within normal limits.

Histologic examination with hematoxylin and eosin (H&E) staining showed normal duodenal mucosa. Gastric mucosa with chronic follicular gastritis and Helicobacter pylori (HP) particles positive.

Lower esophageal tissue showed normal squamous mucosa without signs of reflux esophagitis or increase in eosinophilic number. Biopsies taken from the ulcer of the upper esophagus showed chronic follicular gastritis and HP staining positive as seen in gastric biopsies. Meckel’s scan was performed without detection of ectopic technicium-99m pertechnetate radiations

Patient was treated with triple therapy against HP for 10 days and continued for 2 months with high dose of Proton pump inhibitors (PPI). The clinical symptoms and complains disappeared with increase in his body weight and improvement in his quality of life.

Clinical signs and complains reappeared 4 months later and repeated endoscopy showed same large upper esophageal ulcer and histologically showed gastric tissue and HP staining positive. Quadruple therapy for 14 days eradicated HP infection and prolonged treatment with PPI kept him asymptomatic

Conclusion: Endoscopy and biopsies are recommended in each patient with dysphagia and/or ulcer