An inlet patch is a small area of stomach lining, or gastric mucosa, found in the upper part of the esophagus instead of its usual location in the stomach. This congenital condition arises from an incomplete transformation of tissue during embryonic development. Columnar cells, typically found in the stomach, do not fully convert to the squamous cells that line the esophagus. These patches are most commonly situated in the cervical esophagus, near or just below the upper esophageal sphincter.
Symptoms Associated With an Inlet Patch
Many individuals with an inlet patch are asymptomatic. For those who experience issues, symptoms can include globus sensation (a feeling of a lump in the throat). Dysphagia (difficulty swallowing) is also common.
Other symptoms might include a chronic cough, hoarseness, or frequent throat clearing. Some symptoms can mimic acid reflux, such as heartburn or regurgitation, even though the issue originates higher in the digestive tract. This occurs because the misplaced stomach tissue within the inlet patch can produce acid and digestive enzymes, irritating the sensitive lining of the surrounding esophageal and throat tissues.
The Diagnostic Process
An inlet patch is often discovered incidentally during medical procedures for unrelated reasons. When symptoms suggest its presence, a doctor may investigate. The primary method for identification is an upper endoscopy (EGD).
During an EGD, a thin, flexible tube with a camera is passed down the throat, allowing visualization of the esophageal lining. An inlet patch typically appears as a distinct, salmon-colored area with a velvety texture, contrasting with the paler, smoother tissue of the normal esophagus. To confirm the diagnosis, a biopsy is often collected during the endoscopy and examined under a microscope to verify gastric mucosal cells.
Treatment and Management Strategies
Managing an inlet patch depends on whether an individual is experiencing symptoms. For asymptomatic individuals, treatment is generally not necessary. A “watchful waiting” approach is adopted, where the condition is monitored.
For those with symptoms, initial treatment often involves proton pump inhibitors (PPIs). These medications reduce acid produced by gastric cells within the patch, alleviating irritation, coughing, and discomfort. If medication is ineffective, endoscopic procedures may be considered to remove or destroy the patch tissue. Argon Plasma Coagulation (APC) is a common endoscopic ablation technique that uses ionized argon gas and an electrical current to cauterize the abnormal tissue.
Potential Health Complications
While an inlet patch is generally benign, rare complications can occur. Chronic exposure of esophageal tissue to acid secreted by the patch can lead to issues. These include ulcers (open sores on the esophageal lining) and bleeding.
Prolonged irritation can also result in strictures (narrowings of the esophagus due to scarring) or esophageal webs (thin membranes obstructing food passage). There is an extremely rare risk of developing adenocarcinoma, a type of cancer, within an inlet patch. This low probability can lead some medical professionals to recommend surveillance or removal in specific cases, even without symptoms.