Esophageal Inlet Patch: A Clinically Significant Entity in Advanced Pulmonary Disease and Lung Transplant Rejection

Abstract

Background: Esophageal inlet patch (IP) refers to heterotopic gastric mucosa in the cervical esophagus. Secretions from IP may produce symptoms of laryngopharyngeal reflux (LPR) and accelerate progression of lung disease. We aimed to characterize the significance of IP among patients with advanced pulmonary disease, including lung transplant (LTx) recipients, and to assess outcomes following IP ablation. Methods: We established and reviewed a prospective database of all patients with advanced pulmonary disease referred for GI motility evaluation for presence of IP over 7 years. Total IP size, results of pH testing, incidence of transplant rejection and mortality, and effects of IP ablation on symptoms were analyzed. Results: Twenty-seven (13 LTx recipients) of 440 pulmonary patients referred for upper endoscopy were found to have IPs, and 14 completed IP ablation (mean number of 1.7 sessions to ablate IP). Total IP size correlated with total acid exposure time ( P = .01) and symptoms of cough ( P < .00001), heartburn ( P = .0001), and globus ( P < .00001). Symptom severity of heartburn and dysphagia improved following IP ablation ( P = .04 and 0.008). Eight of 13 LTx patient with IP developed either acute or chronic rejection, with 3 cases of post-LTx mortality occurring in patients who did not undergo IP ablation. Conclusions: IP should be given careful consideration in patients with advanced pulmonary disease and lung transplant recipients, particularly if symptoms of cough, heartburn, or globus are present. Total IP size may be predictive of severity of LPR, and symptom recurrence should prompt re-examination for residual IP.