Ectopic gastric mucosa in the upper esophagus: prevalence and radiologic findings

Ectopic gastric mucosa of the upper esophagus is an asymptomatic benign lesion that may simulate a more serious lesion on radiographs. We studied the radiographic findings and prevalence of this abnormality.

During a 1-year period, 1142 consecutive patients (817 men, 325 women) who had an upper gastrointestinal series as part of an annual health checkup were prospectively studied. Routine examination of the esophagus consisted only of fluoroscopy. Radiographs were obtained if any localized irregularities were found in the upper esophageal wall at fluoroscopy. The findings were subsequently confirmed by endoscopy and biopsy.

Ectopic gastric mucosa in the upper esophagus was seen in 27 (25 men, two women) of the 1142 patients. Forty-three localized ectopic gastric mucosal patches varying in size from 5 mm to 32 mm were detected at the level of the thoracic inlet in the 27 patients. The most common radiographic finding was a pair of small indentations on the wall of the esophagus (18 patches). Other findings included a rimlike shadow (three patches), a pair of somewhat large indentations with a shallowly depressed area between them (two patches), one indentation (five patches), a small flat elevation (one patch), a serrated irregular outline (five radiologic lesions consisted of 11 patches), other various irregular outlines (two patches), and a polypoid area (one patch).

Prevalence of radiographic evidence of ectopic gastric mucosa in the upper esophagus is 2.4%. The lesion was found more commonly in men (3.1%) than in women (0.6%). Radiographic findings include a pair of indentations along the lateral margin of the esophagus and a rimlike shadow on the anterior or posterior wall. Recognition of the characteristic radiographic features of this abnormality makes endoscopy and follow-up unnecessary.