scholarly journals Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome

2009 ◽  
Vol 2009 ◽  
pp. 1-6 ◽  
Author(s):  
Emil Kohan ◽  
David Oh ◽  
Hank Wang ◽  
Salar Hazany ◽  
Gordon Ohning ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Gastric Acid ◽  
Duodenal Bulb ◽  
Duodenal Mucosa ◽  
Heterotopic Gastric Mucosa ◽  
Blue Staining ◽  
Surface Epithelium ◽  
The Novel ◽  
Zollinger Ellison Syndrome ◽  
Gastric Type

Objectives. Zollinger-Ellison Syndrome (ZES) results in hypersecretion of gastric acid (via gastrinoma) leading to peptic ulcers, diarrhea, and abdominal pain. We describe the novel discovery of hypertrophic, heterotopic gastric mucosa in the proximal duodenal bulb in patients with ZES, which we hypothesize results in an increased incidence of postbulbar ulcers in patients with ZES (a mechanism previously unreported). We determined the incidence of the novel finding of duodenal gastric oxyntic hypertrophic heterotopia (GOH) in patients with ZES. Methods. Seven patients with ZES were enrolled. The diagnosis of ZES was established by hypergastrinemia, gastric acid hypersecretion, and a positive secretin test or based on biopsy specimens (evaluated via tissue staining). Basal acid output (BAO) and baseline gastrin secretion were determined by established methods. Endoscopic examinations with methylene blue staining and biopsy of the gastric and duodenal mucosa were conducted in all patients every 3–6 months for an average of 5 years. Results. The duodenal mucosa demonstrated hypertrophic GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. Biopsies from the bowel mucosa demonstrated patchy replacement of surface epithelium by gastric-type epithelium with hypertrophic oxyntic glands in the lamina propria in 5 patients. Two of the patients had no evidence of GOH in the duodenal bulb. Patients with GOH had an average serum gastrin level of 1245 pg/mL and BAO of 2.92 mEq/hr versus 724 pg/mL and 0.8 mEq/hr in patients without GOH. Conclusions. This study demonstrated the presence of duodenal mucosa with GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. The presence of hypertrophic and heterotopic gastric mucosa is proposed to result from increased gastrin levels and may contribute to the increased incidence of postbulbar ulcers in these patients.

scholarly journals Symptomatic Heterotopic Gastric Mucosa in Distal Esophagus

2021 ◽  
Author(s):  
Avnish Kumar Seth ◽  
Mahesh Kumar Gupta ◽  
Gursimran Kaur ◽  
Priti Jain ◽  
Rinkesh Kumar Bansal
Keyword(s):  
Gastric Mucosa ◽  
Squamous Epithelium ◽  
Narrow Band Imaging ◽  
Distal Esophagus ◽  
Heterotopic Gastric Mucosa ◽  
Retrosternal Pain ◽  
Gastric Type ◽  
History Of ◽  
Mass Lesions

Abstract Introduction Heterotopic gastric mucosa (HGM) in esophagus is commonly noted as an inlet patch at endoscopy. We describe a rare patient with symptomatic distal esophageal HGM. Case Report A 40-year-old male presented with retrosternal pain and marked odynophagia for the last 4 weeks without any history of ingestion of antibiotics, foreign body, or corrosive. Endoscopy showed abrupt circumferential transition to salmon pink mucosa at 35 cm from incisors. From 35 to 41 cm, there were areas of polypoid edematous thickening with few superficial ulcers of 1 to 3 mm. Squamous epithelium was visualized at narrow band imaging from 41 cm to the Z-line at 43 cm with no hiatus hernia. Biopsy showed gastric-type mucosa with parietal cells without dysplasia. Serology for cytomegalovirus and human immunodeficiency virus was negative. He was managed with proton pump inhibitors (PPIs) and prokinetics and improved symptomatically. Follow-up endoscopy at 3 months demonstrated healing of ulcers with persistence of HGM and pseudopolyps. He remains well on maintenance with PPI at 1-year follow-up. Conclusion Symptomatic HGM in distal esophagus is rare and can be differentiated from Barrett’s esophagus histologically and by presence of squamous epithelium between HGM and stomach. Inflammatory mass lesions may develop and mimic esophageal malignancy. Symptoms are largely due to acid production and usually respond to PPI.

Gastric and duodenal mucosal ornithine decarboxylase and damage after corticosterone

1990 ◽  
Vol 258 (6) ◽  
pp. G942-G950 ◽  
Author(s):  
J. Y. Wang ◽  
L. R. Johnson
Keyword(s):  
Gastric Mucosa ◽  
Ornithine Decarboxylase ◽  
Single Injection ◽  
Plasma Corticosterone ◽  
Duodenal Mucosa ◽  
Surface Epithelium ◽  
Xiphoid Process ◽  
Maximum Increase ◽  
Dna And Rna ◽  
Microscopic Damage

We recently found that stress increases gastric and duodenal ornithine decarboxylase (ODC) activity and damages both tissues. The current study investigated whether corticosterone induces ODC activity in gastric and duodenal mucosa in rats and compared plasma corticosterone levels after stress and treatment with corticosterone to determine whether this hormone mediated the effects of stress on the mucosa. Rats were fasted 22 h, placed in a restraint cage, and immersed in water to the xiphoid process for 6 h. Stress markedly increased plasma corticosterone levels; the increase was 10.5 times control and lasted the duration of stress. The maximum increase was observed 1 h after a single injection of corticosterone (5 mg/kg sc) and represented 11.1 times control values. By 6 h, plasma corticosterone had returned to normal levels. A single injection of corticosterone had no effect on the gastric mucosa, but duodenal ODC was increased significantly from 4 to 8 h after injection, peaking at 6 h. Histological examination revealed no damage in either tissue. Administration of corticosterone three times daily for 3 days dramatically elevated ODC activity and produced significant microscopic damage. The surface epithelium of the stomach was disrupted, with many surface cells shed, and most villi were absent from the duodenal mucosa. Corticosterone also markedly decreased DNA and RNA content of both tissues. Inhibition of ODC with DL-alpha-difluoromethylornithine additionally decreased DNA, RNA, and protein content, exacerbating the damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Can heterotopic gastric mucosa present as globus pharyngeus?

2006 ◽  
Vol 120 (7) ◽  
pp. 575-578 ◽  
Author(s):  
J L Lancaster ◽  
S Gosh ◽  
R Sethi ◽  
S Tripathi
Keyword(s):  
Gastric Mucosa ◽  
Heterotopic Gastric Mucosa ◽  
Gastric Epithelium ◽  
Anatomical Site ◽  
Small Areas ◽  
Globus Pharyngeus ◽  
Number Of Factors ◽  
Gastric Type ◽  
High Incidence ◽  
History Of

We present a series of four patients presenting with symptoms leading to a provisional diagnosis of globus pharyngeus. On further investigation, they were all found to have small areas of abnormal mucosa in either their hypopharynx or proximal oesophagus, which on biopsy were reported as containing gastric-type mucosa. Following anti-reflux treatment, all patients eventually reported a cessation of symptoms. All but one patient was followed up with repeat endoscopies. We highlight the fact that biopsies reporting gastric epithelium at this anatomical site are in keeping with the diagnosis of heterotopic gastric mucosa. We review the literature and report the high incidence and natural history of this condition.Heterotopic gastric mucosa can only be diagnosed on endoscopy and is easily missed, even during such an investigation. We raise the question of whether this condition may be one of a number of factors in the aetiology of globus pharyngeus.

scholarly journals Diagnostic Value of Endoscopic and Endoscopic Ultrasound Characteristics of Duodenal Submucosal Tumour-Like Heterotopic Gastric Mucosa

2011 ◽  
Vol 25 (7) ◽  
pp. 365-367 ◽  
Author(s):  
Koichi Eguchi ◽  
Kunihiko Aoyagi ◽  
Satoshi Nimura ◽  
Shotaro Sakisaka
Keyword(s):  
Gastric Mucosa ◽  
Endoscopic Ultrasound ◽  
Diagnostic Value ◽  
Heterotopic Gastric Mucosa ◽  
Pathological Examination ◽  
Endoscopic Polypectomy ◽  
Diagnostic Features ◽  
Gastric Glands ◽  
Gastric Type ◽  
Duodenal Epithelium

OBJECTIVE: Recent studies have reported that duodenal heterotopic gastric mucosa (HGM) has been observed in 8.9% of patients who undergo esophagogastroduodenoscopy. However, there are few reports concerning the endoscopic and endoscopic ultrasound characteristics of submucosal tumour-like HGM in the duodenum.METHODS: Endoscopic, endoscopic ultrasound (EUS) and histological findings were analyzed in six patients with submucosal tumour-like HGM, which were confirmed by pathological examination of biopsy or endoscopic polypectomy specimens.RESULTS: Endoscopically, the lesions appeared as a solitary, sessile submucosal tumour-like mass with a depression at the top. In four of six patients, small granular structures were found in the depressed area of the mass. On EUS, all masses demonstrated a heterogeneous pattern, among which four patients presented anechoic areas while two patients showed no anechoic areas. All lesions were localized within the mucosa and submucosa on EUS. Histologically, they consisted of gastric glands and some dilated glands, and were covered with normal duodenal epithelium. In four of six lesions, the tumours were composed of gastric-type foveolar epithelium showing papillary growth, fundic glands and pyloric glands, while the others consisted of gastric-type foveolar epithelium and pyloric glands.CONCLUSION: A heterogeneous pattern on EUS and small granular structures on esophagogastroduodenoscopy represent valuable diagnostic features of submucosal tumour-like HGM.

’Pyloric gland-type adenoma' arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type

1999 ◽  
Vol 435 (4) ◽  
pp. 452-457 ◽  
Author(s):  
R. Kushima ◽  
H. J. Rüthlein ◽  
M. Stolte ◽  
M. Bamba ◽  
T. Hattori ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Heterotopic Gastric Mucosa ◽  
Pyloric Gland ◽  
Gastric Type ◽  
Gland Type

Elevated lesions in the duodenal bulb caused by heterotopic gastric mucosa.

Radiology ◽  
1980 ◽  
Vol 137 (3) ◽  
pp. 621-624 ◽  
Author(s):  
R Langkemper ◽  
A C Hoek ◽  
W Dekker ◽  
J O Op den Orth
Keyword(s):  
Gastric Mucosa ◽  
Duodenal Bulb ◽  
Heterotopic Gastric Mucosa

scholarly journals A case of gastric and duodenal mucosa-associated lymphoid tissue lymphoma with multiple gastric cancers: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takashi Yokoyama ◽  
Tetsuya Tanaka ◽  
Suzuka Harada ◽  
Takeshi Ueda ◽  
Goki Ejiri ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Malt Lymphoma ◽  
Lymphoid Tissue ◽  
Regional Lymph Node ◽  
Duodenal Bulb ◽  
Duodenal Mucosa ◽  
Upper Endoscopy ◽  
Gastric Cancers ◽  
Regional Lymph Node Dissection ◽  
H Pylori

Abstract Background Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is often caused by Helicobacter pylori and has a good prognosis. Rarely, patients with MALT lymphoma may have gastric cancer and have a poor prognosis. Case presentation We herein report a case in which surgical treatment was achieved for a 72-year-old male patient with gastric and duodenal MALT lymphoma coexisting multiple gastric cancers. He underwent upper endoscopy for epigastric discomfort, which revealed mucosal erosion on the posterior wall of the middle body of the stomach, an elevated lesion on the duodenal bulb, and a raised tumor on the antrum of the stomach. He was diagnosed with gastric and duodenal MALT lymphoma with early gastric cancer. One month after H. pylori eradication, a second upper endoscopy revealed no improvement in the gastric or duodenal mucosa, and areas of strong redness with a shallow recess just below the cardia of the stomach. As a result, a diagnosis of gastric and duodenal MALT lymphoma with two gastric cancers was made. Total gastrectomy with proximal duodenum resection using intraoperative upper endoscopy and regional lymph node dissection was performed. Pathologically, gastric and duodenal MALT lymphoma and three gastric cancers were detected. Since one of them was an advanced cancer, he started taking S-1 after his general condition improved. Conclusion For early detection of gastric and duodenal MALT lymphoma or gastric cancer, appropriate upper endoscopy and a biopsy are important. It is necessary to select a suitable treatment, such as H. pylori eradication, endoscopic treatment, surgery, chemotherapy, and irradiation, according to the disease state.

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