Ectopic gastric mucosa refers to the presence of stomach lining tissue in unusual locations throughout the body. This condition is a developmental anomaly. It can also be called heterotopic gastric mucosa.
What is Ectopic Gastric Mucosa?
Ectopic gastric mucosa occurs when stomach-like tissue is found in areas of the body where it does not normally belong. The term “ectopic” signifies that the tissue is in an abnormal position, while “gastric mucosa” refers to the specialized lining of the stomach. This lining contains glands and cells that produce mucus and digestive acids, characteristic of the stomach’s function.
The underlying cause of ectopic gastric mucosa is an error during embryonic development. Gastric mucosal cells may migrate to or differentiate in an incorrect location, resulting in this misplaced stomach lining.
Common Locations and Manifestations
Ectopic gastric mucosa can appear in various parts of the body, most frequently within the gastrointestinal tract. A common location is the esophagus, particularly the upper esophagus, where it is often termed an “inlet patch.” These patches appear as oval, salmon-pink areas and can be single or multiple. While many esophageal inlet patches do not cause symptoms, some can secrete acid, leading to issues like heartburn, difficulty swallowing (dysphagia), or bleeding.
Another notable location is Meckel’s diverticulum, a common congenital anomaly of the small intestine. About half of Meckel’s diverticula contain ectopic gastric mucosa. The acid produced by this misplaced tissue can cause ulceration, bleeding, or perforation of the diverticulum, leading to abdominal pain or gastrointestinal bleeding.
Ectopic gastric mucosa can also be found in other rare locations, including the small intestine beyond Meckel’s diverticulum, the rectum, gallbladder, and pancreas. In the small intestine, it may lead to inflammation, ulceration, or obstruction. If present in the gallbladder, it might cause symptoms similar to typical gallbladder disease.
How Ectopic Gastric Mucosa is Diagnosed
Diagnosing ectopic gastric mucosa typically involves visual identification and tissue analysis. Endoscopic procedures are the primary method used to identify this condition. An upper endoscopy, for instance, allows a healthcare provider to directly visualize the lining of the esophagus and stomach. If the ectopic tissue is suspected in other parts of the digestive tract, such as the colon or small intestine, a colonoscopy or other specialized endoscopic procedures may be performed.
During the endoscopic examination, the physician looks for characteristic appearances of ectopic gastric mucosa, such as the salmon-pink patches often seen in the esophagus. To confirm the diagnosis, a biopsy of the suspicious tissue is taken. This tissue sample is then examined under a microscope by a pathologist to identify the presence of gastric-type cells. While imaging studies like CT scans or barium swallow tests may sometimes suggest the presence of ectopic tissue, a definitive diagnosis relies on the histological confirmation from a biopsy.
Treatment and Management Approaches
The approach to treating ectopic gastric mucosa is individualized, depending on the tissue’s location, whether it causes symptoms, and if there are any complications. For individuals with asymptomatic ectopic gastric mucosa, particularly small patches, observation and monitoring may be recommended by a healthcare provider.
When symptoms arise, medical management is often the first line of treatment. Acid-suppressing medications, such as proton pump inhibitors (PPIs) or H2-blockers, are commonly used to reduce acid production from the ectopic gastric mucosa and alleviate symptoms like heartburn or pain. If medical therapy is insufficient or if complications like significant bleeding or strictures develop, endoscopic procedures may be considered. Techniques such as argon plasma coagulation or radiofrequency ablation can be used to remove or destroy the abnormal tissue. In more severe cases, or for complications such as intestinal obstruction or perforation, surgical removal of the ectopic gastric mucosa may be necessary.