Inlet Patch

(This page was written with the help of AI.)

Inlet patch, also known as cervical inlet patch or gastric inlet patch, is a relatively uncommon but noteworthy medical condition closely associated with acid reflux (gastroesophageal reflux disease, or GORD). 

What is an Inlet Patch:

An inlet patch is a distinctive anomaly that occurs in the upper oesophagus which is usually lined with flat squamous cells. However, in individuals with an inlet patch, a small region of gastric columnar cells may be found in the oesophagus, similar to Barrett's Oesophagus which can form at the lower end of the oesophagus, though may not have goblet cells.

Symptoms and Complications:

Inlet patches can present a spectrum of symptoms, often overlapping with those of typical GORD. Common symptoms include:

1.  Heartburn: The regurgitation of stomach acid into the esophagus, in proximity to the inlet patch, can cause heartburn, characterized by a burning sensation in the chest.

2. Chest Pain: Discomfort or chest pain may occur, sometimes mimicking cardiac-related issues. This is particularly problematic, as it can lead to unnecessary diagnostic evaluations.

3. Difficulty Swallowing: Irritation or inflammation in the vicinity of the inlet patch can result in dysphagia, making it uncomfortable to swallow food or even saliva.

4. Globus Sensation: Some individuals may experience the feeling of a lump or foreign object stuck in their throat.

5. Chronic Cough:  Like extra-oesophageal reflux, Inlet patches can also trigger a persistent cough, as gastric contents may aspirate into the respiratory system.

6.  Laryngitis: The irritation can extend to the larynx, leading to symptoms like hoarseness, a sore throat, and voice changes.

It's essential to note that the severity and specific symptoms can vary from person to person, making the diagnosis of inlet patch challenging.

Diagnosis:

Diagnosing an inlet patch typically involves the following procedures:

1.  Upper Endoscopy (Oesophagogastroduodenoscopy or OGD): A minimally invasive procedure in which a flexible tube equipped with a camera is inserted through the mouth and down into the esophagus and stomach. The inlet patch's presence can be visually confirmed during this examination.

2. Biopsy: During the endoscopy, a tissue sample, or biopsy, is often taken to confirm the presence of gastric mucosa in the esophagus.

Treatment Options:

Managing an inlet patch and its associated symptoms can be challenging but is attainable. Treatment options typically include:

1.  Acid Suppression: Proton pump inhibitors (PPIs) or H2 blockers may be prescribed to reduce acid production in the stomach, minimizing irritation in the inlet patch region.

2. Lifestyle Modifications: Similar to GORD, lifestyle changes can help manage symptoms.

3. Surgical Intervention: In cases of severe or refractory symptoms, surgical correction may be considered. Procedures like fundoplication, which wraps the top of the stomach around the lower esophagus, can help prevent acid reflux.

Inlet patches can pose a significant diagnostic challenge due to their less common nature, at times masquerading as other medical conditions. 

Some recent papers:

Inlet patch: prevalence, histologic type, and association with esophagitis, Barrett esophagus, and antritis "Inlet patch occurred in about 1% of our study population. Oxyntic mucosa constituted the most common histologic type; inflammation was common. The H pylori infection of the inlet patch correlated with that of the antrum. None of the inlet patch biopsies showed intestinal metaplasia. Pancreatic acinar tissue occurred with similar frequency in the inlet patch and distal esophagus. Esophagitis was noted in 25% of the patients with inlet patch, and Barrett esophagus was noted in 20%." (Archives of Pathology & Laboratory Medicine 2004)

Esophageal inlet patch "An inlet patch is a congenital anomaly consisting of ectopic gastric mucosa at or just distal to the upper esophageal sphincter. Most inlet patches are largely asymptomatic, but in problematic cases complications related to acid secretion such as esophagitis, ulcer, web and stricture may occur." (Radiology Research & Practice 2011)

Cervical inlet patch: new insights into diagnosis and endoscopic therapy "The cervical inlet patch is an island of heterotopic gastric mucosa, most commonly found in the proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus sensation. This has led to a change in the Rome IV criteria for globus management, with emphasis on ruling out the condition. Proton pump inhibitors are often ineffective in resolving symptoms. Endoscopic studies on the use of ablative techniques, most recently radiofrequency ablation (RFA), have shown promise in reversing the CIP to mormal squamous mucosa, with subsequent symtpomatic resolution." (Frontline Gastroenterology 2018)

Issues and controversies in esophageal inlet patch "Due to its potential underdiagnosis, there are no consensus guidelines for the management and follow up of inlet patches. This review focuses on questions that were raised from published literature on esophageal inlet patches in adults." (World Journal of Gastroenterology 2019)

Esophageal Inlet Patch: Association with Barrett's Esophagus "Our study reports an IP prevalence of 1.3%, with 17.1% patients having concomitant BE; and a BE prevalence of 4.9%, with 4.6% also having IP. Patients with IP alone presented with similar symptoms to patients with concomitant BE. Esophageal function testing showed that patients with either IP or BE had decreased LES pressures and increased esophageal AET [Acid Exosure Time]. During endoscopy, patients found to have one of these findings should be carefully examined for the other." (Digestive Diseases and Sciences 2023)

Page updated 5 March 2025