Inlet Patch in Children: Clinical and Pathological Characteristics of 18 Cases
Alexis Bousamra, Ali G Saad. University of Arkansas for Medical Sciences, Little Rock, AR
Background: Inlet patch (IP) is considered a congenital anomaly of the cervical esophagus consisting of gastric mucosa. We conducted this project to report the characteristics of IP in children. To our knowledge, IP in children has not been explored before.
Design: Children who underwent gastro-esophageal endoscopy at Arkansas Children's Hospital between July 2010 and April 2011 are included in this study. In each patient, the esophagus was carefully examined endoscopically with special attention to look for IP. Immunohistochemistry for Helicobacter pylori (Hp) was performed on both the gastric biopsies and IP biopsies when there was chronic and/or active gastritis in either location.
Results: A total of 393 patients (217 males and 176 females) underwent esophago-gastric endoscopy during this period (median age: 6 months-18 years). IP was identified in 18 patients (10 males and 8 females) with corresponding incidence of 4.58%. Median age was 12.1 years (range 5.3-18.0 years). No IP was identified in any patient younger than 5 years. Types of gastric mucosa included antral (11 patients; 61.1%), fundic (2 patients; 11.1%) and antral and fundic (5 patients; 27.8%). Chronic gastritis was present in 8 patients (44.4 %), chronic patchitis in 5 (27.8%), and concomitant chronic gastritis and patchitis in 3 (16.7%). Chronic active gastritis was present in 1 patient (5.6%) and chronic active patchitis was present in 1 patient (5.6%). In this patient, the stomach showed no abnormality. In five patients (27.8%), both the stomach and IP showed no abnormality. Hp immunostain was positive in both the stomach and IP in only one patient (5.6%). No other patient showed Hp positivity in neither the stomach nor the IP.
Indications for endoscopic evaluation included abdominal pain (15 patients; 83.3%) and nausea and vomiting (3 patients; 16.7%). Associated symptoms were heartburn in 12 patients (66.7%), and dysphasia in 5 (27.8%). Six patients (33.3%) had history of cigarette smoking, 2 (11.1%) had history of marijuana smoking, 3 (16.7%) used alcohol for al least 18 months prior to presentation, and 10 (55.5%) had exposure to passive smoking. There was strong correlation between the presence of heartburn and IP (P=0.005).
Conclusions: Our results suggest that IP is an acquired condition and not a congenital anomaly. There was a strong correlation between IP and heartburn. Albeit statistically not significant, we found a correlation between IP and passive smoking. Because adults with IP have increased risk of intestinal metaplasia and neoplasia, these children may benefit from close follow up.
Monday, March 19, 2012 1:00 PM
Poster Session II # 87, Monday Afternoon