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Neurogastroenterology and motility
Apr, 2024;36 (4): e14768.

A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches.

L Ayres, S Perring, S A R Nouraei
Author Information
  1. L Ayres: Department of Gastroenterology, University Hospitals of Dorset NHS Foundation Trust, Poole, UK.
  2. S Perring: Department of Medical Physics, University Hospitals of Dorset NHS Foundation Trust, Poole, UK.
  3. S A R Nouraei: The Clinical Informatics Research Unit, University of Southampton, Southampton, UK. ORCID
PMID: 38487993 DOI: 10.1111/nmo.14768

Abstract

INTRODUCTION: Gastric inlet patches are often incidental, but can also be a treatable cause of laryngo-esophageal symptoms.
METHODS: We retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically-Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24-h pH-impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI-Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100].
KEY RESULTS: Inlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness (n = 33), throat symptoms (n = 24), and dysphagia (n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > - 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001).
CONCLUSIONS: Gastric inlet patches are common and under-recognized. They can cause protracted pharyngo-esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.

Keywords

Argon plasma coagulation Transnasal Panendoscopy esophageal physiology gastric inlet patch

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MeSH Term

Male
Humans
Middle Aged
Retrospective Studies
Bays
Gastric Mucosa
Gastroesophageal Reflux
Stomach
Electric Impedance
Esophageal pH Monitoring
Journal Article

Word Cloud

Created with Highcharts 10.0.0patchessymptomsinletpatientsAPCgastricresponseDistalMeanImpedanceGastriccancausefollowingswallowingArgonthroatMNBIMucosalGradientTransnasalPanendoscopy34patientselectionmultidisciplinaryINTRODUCTION:oftenincidentalalsotreatablelaryngo-esophagealMETHODS:retrospectivelyreviewedwhosediagnosedassessmentlaryngopharyngealImprovementPlasmaCoagulationassessedusingMinimumClinically-ImportantDifferencemethodologycombiningvoicedomainsCorrelationsmeasuresrefluxmucosalbarrierintegritymeasured24-hpH-impedancemanometryobtainedProximalNocturnalBaselinevaluesseparatelycalculatednovelvariablederived[MNBI-Proximal/MNBI + ProximalMMBI/2 x 100]KEYRESULTS:Inletdetected5765187 ± 22%malesage58 yearsduration2 yearscommonesthoarsenessn = 33n = 24dysphagian = 21respectivelyusedablateTreatment71%meanfollowup55 monthsMIG > - 25%predictedareareceiveroperatingcharacteristiccurve0875Sensitivity = 81%Specificity = 100%p < 00001CONCLUSIONS:commonunder-recognizedprotractedpharyngo-esophagealPatchablationeffectivetreatmentcarefullyselectedOptimalrequiresteamworkrefineapproachidentifyingmanagingheterotopicplasmacoagulationesophagealphysiologypatch

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