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Pediatric Heterotopic Gastric Mucosa of the Cervical Esophagus (Inlet Patch): Case Series with Clinical, Endoscopic,
Javier Arredondo Montero1, Samuel Sáez Álvarez2, Andrea Herreras Martínez3
1Pediatric Surgery Department, Complejo Asistencial Universitario de León, 24008 León, Castilla y León, Spain.
Insights
Inlet patch (IP), a congenital anomaly of gastric tissue in the esophagus, is poorly understood in children. This study found a potential link between IP inflammation, stomach gastritis, and H. pylori infection in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Congenital Anomalies
Background:
- Inlet patch (IP) is gastric heterotopia in the cervical esophagus, well-documented in adults but understudied in children.
- Understanding pediatric IP is crucial for accurate diagnosis and management.
Purpose of the Study:
- To characterize pediatric inlet patch (IP) prevalence, clinical presentation, and associated findings.
- To investigate potential associations between IP inflammation, gastric inflammation, and Helicobacter pylori (H. pylori) infection.
Main Methods:
- Retrospective analysis of pediatric patients (0-14 years) diagnosed with IP from 2018-2025.
- Clinical data review, endoscopic assessment, and histopathological evaluation of IP inflammation.
- Correlation analysis with concurrent gastric findings and H. pylori status.
Main Results:
- Nine pediatric patients (median age 12) diagnosed with IP; 67% presented with cervical esophageal symptoms like dysphagia.
- Endoscopy revealed characteristic salmon-red plaques in all patients; histology confirmed gastric heterotopia with inflammation.
- A potential association was noted between IP inflammation severity, gastric gastritis, and H. pylori presence (75% of severe IP inflammation cases had H. pylori gastritis).
Conclusions:
- Increased targeted examination of the cervical esophagus improved pediatric IP detection.
- While often incidental, symptomatic pediatric IP can occur and may be linked to H. pylori.
- Further research is needed to clarify the clinical significance and optimal treatment strategies for pediatric IP.
Abstract:
Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0-14 years) diagnosed with IP between 2018 and 2025. Sociodemographic and clinical data were collected. A blinded pathologist assessed the presence and severity of inflammation within the IP. Results: Nine patients (median age, 12 years; range, 6-14 years) were included, with 78% beingmale. Cervical esophageal symptoms were identified in 67%, primarily dysphagia and gastroesophageal reflux disease-related complaints, although concomitant conditions such as eosinophilic esophagitis were frequently present. Three patients had symptoms potentially attributable to IP (33%). Endoscopic examination revealed characteristic well-demarcated salmon-red plaques in all patients, with multiple lesions observed in three cases. Histology confirmed gastric heterotopia with varying degrees of chronic inflammation in all cases. A potential association was observed between the severity of gastritis in the stomach, the severity of inflammation in the IP, and the presence of H. pylori, with 75% of patients with moderate-to-severe IP inflammation also exhibiting gastric H. pylori-associated gastritis. All patients except one received proton pump inhibitors, and symptoms improved in all cases. Conclusions: A thorough and targeted examination of the cervical esophagus significantly increased IP detection at our center, with most cases (89%) being diagnosed in the last 12 months. While mostly asymptomatic and incidental, IP can be symptomatic. In this case, series, we found a possible association between the severity of inflammation in the IP, the severity of gastritis, and the presence of H. pylori. Further studies are needed to define the clinical significance of pediatric IP and optimal management.
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