Stephen Curtis, MD, Adam Tritsch, MD
Walter Reed National Military Medical Center, Bethesda, MD
Introduction: Inlet patches are a congenital anomaly of the cervical esophagus which are comprised of heterotropic gastric mucosa and have been reported in 1-12% of patients on endoscopy. Typically, this finding is seen distal to the upper esophageal sphincter, and appears endoscopically as a salmon colored patch which contrasts against normal esophageal mucosa. Rarely, inlet patches become symptomatic due to mucosal changes leading to ulceration, neoplasia or stricturing. We present a case of an ulcerated inlet patch leading to iron deficiency anemia.
Case Description/Methods: The patient was a 41 year old African American female, who was admitted with a cardioembolic stroke (CVA). On admission, hemoglobin was noted to be 5.8 g/dL with an MCV of 55 fl. Her iron panel was suggestive of iron deficiency anemia (TIBC 455 ug/dL, Ferritin 5 ng/ml, Iron Saturation 4.4%). She denied having gastrointestinal symptoms, overt bleeding and she endorsed only having light bleeding during menstruation. EGD and colonoscopy were performed to further evaluate her anemia. Colonoscopy with intubation of the terminal ileum was unremarkable however, EGD revealed an ulcerated gastric inlet patch with adherent clot at 20 cm from incisors. No other obvious bleeding source was identified on EGD. Given her recent initiation of anticoagulation for cardioembolic stroke and absence active bleeding, the decision was made to not perform any endoscopic interventions. She was started on a proton pump inhibitor and serology for Heliobacter pylori (HP) IgG obtained. When this returned was positive she was initiated on triple therapy.
Discussion: This represents a rare case of an ulcerated gastric inlet patch resulting in iron deficiency anemia. Literature suggests that there may be high concordance of Helicobacter pylori colonization of inlet patches in patients with colonization of the stomach. Potentially this could be a unifying diagnosis of her HP serology positivity and an ulcerated inlet patch. This case also highlights the importance of deliberate visualization of the esophagus during EGD where proximal esophageal lesions can be easily missed.
Citation: Stephen Curtis, MD, Adam Tritsch, MD. P1199 - A RARE COMPLICATION OF A COMMON FINDING: A CASE OF IRON DEFICIENCY ANEMIA SECONDARY TO AN ULCERATED INLET PATCH. Program No. P1199. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.