**4. Classification**

130 Gastrointestinal Endoscopy

the antral mucosa. The authors concluded that the similarities between HGMP/CIP and Barrett's esophagus but not with normal antral mucosa fit with the hypothesis that both lesions may originate from sub-mucosal esophageal mucous glands. Despite this, there are differences seen between HGMP/CIP and Barrett's esophagus. Staining pattern was also different between HGMP/CIP and the embryogenic esophagus. The authors of this study suggested that HGMP/CIP etiology may be different, congenital in children or

The HGMP/CIP can also be colonized by *Helicobacter pylori* and the patches are subjected to changes that are seen in the stomach (Akbayir et al., 2004; Alagozlu et al., 2010; Borhan-Manesh & Franum, 1991 & 1993; Gutierrez et al., 2003; Jacobs et al., 1997; Maconi et al., 2000; Poyrazoglu et al., 2009; Tang et al., 2004; Yüksel et al., 2008). Chronic inflammatory changes can be seen and progression to atrophy, intestinal metaplasia, dysplasia and malignant transformation have been reported (Borhan-Manesh & Franum, 1991). The surrounding squamous cell mucosa can also show inflammatory changes similar to those seen in reflux

Fig. 5. (a) Cytokeratin (CK) 7 staining of HGMP/CIP showing uptake in the surface glandular tissue similar to that seen in Barrett's esophagus (b). CK20 staining uptakes are

similar in HGMP/CIP (c) and Barrett's esophagus (d)

esophagitis (Borhan-Manesh & Franum, 1991).

babies and acquired in adult.

a) b)

c) d)

A clinico-pathologic classification has been proposed by von Rahden *et al.* (von Rahden et al., 2004) which categorized patients with HGMP into five groups (I to V) based on the clinical, endoscopic and histological findings (Table 1). This classification also takes into account of small patches that may be only visible microscopically. Based on this classification, majority of the HGMP/CIP are categorized into types I and II, asymptomatic and mildly symptomatic respectively. One study found that the most common lesions are types I (73%) and II (27%) lesions.


Adapted from von. Rahden *et al*. Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification. Am J Gastroenterol. 2004; 99:543-51. \* Not included in the original classification

Table 1. Clinico-pathological classification for HGMP/CIP
