P0303 - Removal of an Inlet Patch Leads to an Improvement in Symptoms of Globus, Chronic Cough and Hoarseness in Select Patients

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

William I. Buniak, DO, MS

Stony Brook University Hospital-Southampton Campus
Manorville, NY, United States

William I. Buniak, DO, MS¹, Borys Buniak, MD²
¹Stony Brook University Hospital-Southampton Campus, Manorville, NY; ²Heartburn Center at Saint Joseph's Hospital Health Center, Fayetteville, NY

Introduction: The inlet patch (IP) is a frequently missed lesion of heterotopic gastric mucosa with varying reported levels of prevalence. Although typically thought to be a benign finding, we have found that there is a link between IPs and patient symptoms of chronic cough, heartburn, and globus after other causes are ruled out by EGD or pH probe. In our study we postulated that ablating the IP will alleviate patients' symptoms.

Methods: Patients with histologically confirmed IP on screening EGD between 2017-2019 were selected. Of that cohort patients with chronic cough, heartburn and globus who failed PPI and H2 blocker therapy were offered to have their IP removed either with radiofrequency ablation (RFA), argon plasma coagulation (APC) or biopsy forceps. Patients were followed up afterward to see if there was an improvement of their symptoms.

Results: Of 3,269 patients undergoing EGD at our center between 2017-2019, 50 were found to have an IPs. Ages ranged from 24-78 years of age, mean age of 56.4, median age of 51. 10 patients also had Barrett's esophagus. 38% of patients initially had heartburn, 24% dysphagia, 20% chronic cough, 18% throat clearing, 14% globus, 4% nausea. Three patients were asymptomatic. 23 patients underwent RFA or manual removal of IPs. Clearance of IP was confirmed by repeat EGD. Of the 23 who underwent IP removal, 14 (60% of total) had either complete or partial resolution of symptoms. No adverse events reported.

Discussion: Although IPs have been considered clinically irrelevant, we have evidence that they may be the etiology of several common symptoms such as chronic cough, globus or heartburn after other causes were ruled out. Partially this may be due to IPs not being characterized on exam. IPs are either congenital or acquired from chronic acid exposure which later develops the ability to secrete its own acid through oxyntic cells within the patch. These IPs rarely benefit from aggressive acid blocking therapy. In our study we found that symptoms secondary to IPs improved in a vast majority of patients after RFA, APC or manual removal. Some further avenues of research could compare methods of removal as well as determining efficacy of removal when patients have other concomitant GI conditions. Although the study population was small, the magnitude of the number of patients with improvement of symptoms was significant. Our results suggest that further studies are necessary to select which symptomatic individuals could benefit from IP ablation.

Figure: A. Single inlet patch, B-C. Inlet patch ablation with APC

Patient	Pre-Symptoms	Meds	Age	RFA/APC	Post-Symptoms	Barrett's

1	Cough	PPI	55	Yes x1	Resolved	Neg
2	Globus	PPI	60	Yes X1	Resolved	Neg
3	Cough		61	Yes x1	Resolved	Neg
4	Cough, clears throat	PPI	75	Yesx2	Resolved	Neg
5	GERD	PPI	51
6	GERD	PPI	69			Yes
7	GERD, clears throat	PPI	57	Yes x1	Resolved	Neg
8	Sore throat	H2	58
9	GERD	PPI	50
10	clears throat		60	Bx off		Neg
11	Cough, clears throat	PPI	70	Yes	Improved
12	cough dysphagia.	PPI	76	Yes x3	Resolved	Neg
13	clears throat		61	Yes x1	No change	Neg
14	GERD	PPI	55			Neg
15	cough globus	PPI	67	Yes x1	Resolved	No
16	GERD, clears throat	PPI	60			Yes
17	GERD		53			Yes
18	GERD		56	Yes x1	Resolved	Neg
19	GERD	PPI	60		OK on PPI	No
20	Dysphagia	PPI	37	Bx off	No change	Neg
21	Dysphagia	PPI	53			Neg
22	Dysphagia		71			Neg
23	Dysphagia, GERD	PPI	40	Bx off		Neg
24	Cough, clears throat	PPI	42	Yes x3	Resolved	Yes
25	Cough, Dysphagia		68	Bx off	No change	Neg
26	Dysphagia	PPI	39	Bx off	No change	Neg
27	sore throat	PPI	54		No symptoms	Neg
28	cough	PPI	60		OK on PPI	Neg
29	bad teeth	PPI	48			Yes
30	GERD	PPI	57			Neg
31	globus dysphagia	PPI	52		Ok on PPI
32	globus dysphagia	PPI	36	Yes x1	No globus	Neg
33	cough globus	PPI	45	Yes x1	Resolved	Neg
34	dysphagia		51	Bx off	Improved
35	globus dysphagia	H2	63	Yes x1	Improved	Neg
36	no symptoms		47			Neg
37	GERD	H2	76		OK on H2
38	GERD		56		No symptoms	Neg
39	GERD	PPI	59		OK on PPI	Yes
40	GERD		78		OK on PPI	Neg
41	GERD	PPI	64			Neg
42	Nausea	PPI	75			Neg
43	GERD	PPI	46			Yes
44	GERD		68			Yes
45	Globus, dysphagia	H2	68			Yes
46	GERD	PPI	47	Bx off		Yes
47	GERD	PPI	25		OK on PPI	Neg
48	Nausea		24	Bx off		Neg
49	GERD	H2	47			Neg
50	Dysphagia	PPI	70	Bx off		Neg

Table: Patient list of symptoms and response to treatment. RFA (Radio frequency ablation), APC (Argon plasma coagulation) PPI (Proton pump inhibitors) Bx (Biopsy off), H2 (Histamine-2 blockers)

Disclosures:

William Buniak indicated no relevant financial relationships.

Borys Buniak indicated no relevant financial relationships.

William I. Buniak, DO, MS¹, Borys Buniak, MD². P0303 - Removal of an Inlet Patch Leads to an Improvement in Symptoms of Globus, Chronic Cough and Hoarseness in Select Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.