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Introduction: Duodenal lesions are rare, with incidence ranging from less than 1% to 5%. However, their incidence has increased with more advanced endoscopic techniques and the widespread use of upper endoscopy. Gastric Heterotopia (GH) is a rare occurrence in which gastric tissue is found outside of the stomach. It usually occurs in the form of polyps, nodules, or tumor growths. Here we present a rare case of biopsy-proven duodenal polypoid gastric heterotopia. Case: A 27-year-old male with a past medical history of obesity, hepatic steatosis, hypertension, hypothyroidism, and prediabetes was referred for an upper endoscopic evaluation due to dyspepsia. Esophagogastroduodenoscopy (EGD) showed mild gastritis and a few duodenal polyps. Biopsies of the stomach showed mild chronic inflammation and reactive epithelial changes, though negative for H. pylori. Biopsies of the duodenum revealed gastric heterotopia, which was negative for dysplasia. A repeat EGD with endoscopic ultrasound (EUS) showed erythematous mucosa of the stomach and multiple medium-sized pedunculated and sessile polyps in the duodenal bulb. The largest polyp was removed with a hot snare technique, and a hemostatic clip was placed to prevent post-polypectomy bleeding. The biopsy revealed polypoid gastric heterotopia (gastric oxyntic mucosa overlying hyperplastic Brunner's glands) that was negative for dysplasia or invasive neoplasm. His dyspepsia resolved with once-daily omeprazole, and a repeat EGD in six months was scheduled for continued surveillance. Discussion Gastric Heterotopia is a benign condition in which gastric mucosa is identified outside its typical location within the gastrointestinal tract. Heterotopia is a developmental anomaly, whereas metaplasia is an acquired condition or reactive process. Therefore, heterotopia is considered congenital in nature. GH is described as macroscopic lesions on gastrointestinal radiographs or endoscopy and confirmed by biopsies. Histology findings show full mucosal thickness of specialized gastric glands composed of chief and parietal cells lined by foveolar epithelium. When gastric tissue is located within the duodenum, it is referred to as duodenal gastric heteropia (DGH). DGH is considered a rare phenomenon, with a more recent large endoscopy study reporting an incidence rate of 1.9% in patients undergoing endoscopy. The incidence in the general population is estimated to be approximately 0.5 to 2%. GH is considered benign and often asymptomatic but may present with symptoms of pain, perforation, intussusception, bleeding, or obstruction. On rare occasions, GH has been associated with dysplasia and adenocarcinoma. Therefore, prompt identification of duodenal lesions is essential to guide proper treatment. |
