Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction.
BACKGROUND
An inlet patch of gastric mucosa in the upper esophagus is usually an incidental, congenital finding found during upper gastrointestinal tract endoscopy. Although it has been reported to cause dysphagia, strictures, adenocarcinoma, and webs, it has never been associated with cough and vocal cord dysfunction.


OBJECTIVE
To report the first case of a patient with an inlet patch of gastric mucosa in the upper esophagus as the cause of a particularly troublesome, chronic cough that was initially missed on 2 upper endoscopies.


METHODS
The patient is a 50-year-old man with a 7-year history of chronic cough associated with hoarseness, shortness of breath, and globus sensation. For diagnostic evaluation, pulmonary function tests, chest computed tomography, rhinolaryngoscopy, upper gastrointestinal tract endoscopy, and histologic examinations were performed.


RESULTS
A multidisciplinary approach revealed several possible causes for the chronic cough, including vocal cord dysfunction, postnasal drip syndrome, allergic rhinitis, and mild gastroesophageal reflux disease that was only partially responsive to therapy. The results of 2 initial upper gastrointestinal tract endoscopies were interpreted as normal. A third endoscopy detected an inlet patch of gastric mucosa in the upper esophagus. Treatment with a high-dose histamine type 2 receptor antagonist and a proton pump inhibitor alleviated the patient's symptoms.


CONCLUSIONS
An inlet patch of gastric mucosa in the upper esophagus is not uncommon, but it is often overlooked or believed to be an incidental, congenital finding. This is the first report, to our knowledge, of an inlet patch resulting in a troublesome, chronic cough.
Silvers
William S
WS
Allergy, Asthma, & Immunology Clinic of Colorado, Englewood, Colorado 80111, USA. skiersnoz@silversmd.com
Levine
Joel S
JS
Poole
Jill A
JA
Naar
Erick
E
Weber
Richard W
RW
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000730:Androstadienes / Q000627:therapeutic use; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal; D004935:Esophageal Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000068298:Fluticasone; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D064747:Lansoprazole; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D012129:Respiratory Function Tests; D014827:Vocal Cords / Q000503:physiopathology*
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000730:Androstadienes; D018926:Anti-Allergic Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D000068298:Fluticasone; D009853:Omeprazole