Özofagusun Heterotopik Gastrik Mukozası: İnlet Patch
Özet
Heterotopik gastrik mukozanın servikal özofagusta yerleşimi inlet patch olarak tanımlanır ve konjenital bir anomalidir. Semptomlar ve morfolojik değişiklikler, heterotopik gastrik mukozanın salgılamış olduğu asit hasarına bağlıdır ve ileri yaşlarda, malign transformasyon ve adenokarsinogenezis gelişebilmektedir. Klinik bulguları göğüs ağrısı, karın ağrısı, disfaji ve odinofaji şeklindedir. Konservatif tedaviye yanıt vermeyen hastalarda, argon lazer plazma koagülasyonu, cerrahi eksizyon gerekebilmektedir. Bu bölümde, gastroduodenoskopisinde inlet patch tespit edilen bir erkek hastadan bahsedilmektedir. Uzun süredir devam eden yutma güçlüğü, boğazda yanma ve sol yan ağrısı şikayetleri ile kliniğimize başvuran 13 yaş erkek hasta, fizik muayenesinde belirgin bir özellik yoktu. Yapılan laboratuvar tetkikleri normaldi. Hastaya yapılan üst gastrointestinal endoskopide, reflü özefajit bulguları, özofagusun üst kısmında, 15. cm’de mide mukozasına benzer alanlar(inlet patch), pangastrit mevcuttu. Histopatolojik incelemede, kronik gastrit, H.Pylori(+), reflü özefajit ile uyumluydu. Hasta, proton pompa inhibitörü (PPI) ve Tedavinin 6. haftasında hastanın şikayetlerinde belirgin düzelme görüldü. Hastaya düzenli endoskopik takip, diyet ve ilaç tedavisi önerildi. İnlet patch, çoğu zaman asemptomatik olup tesadüfen saptanmakla birlikte, bazen ciddi semptomlara yol açabilir. Bu nedenle, özellikle açıklanamayan yutma güçlüğü ve boğaz yanması şikayetleri olan genç hastalarda inlet patch düşünülmeli ve uygun tanı yöntemleri ile doğrulanmalıdır. Erken tanı ve tedavi, hastanın yaşam kalitesini önemli ölçüde artırabilir.
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