Editor's quiz: GI snapshot
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From the question on page 1192
The pathological result of the rectal lesion is heterotopic gastric mucosa, which has been reported throughout all the gastro-intestinal tract, but is rare in the rectum with about 40 cases reported in the literature.1–3 The most common presentation is rectal bleeding. Other, less frequent, presenting symptoms are perineal ulceration, anal pain, tenesmus, abdominal pain and melena. Heterotopic tissue can also be discovered incidentally during colonoscopy for colorectal cancer screening, anaemia or irritable bowel syndrome.3 Treatment modalities include H2 blockers, intrarectal alkalines, proton pump inhibitors, ablation or fulguration and surgical excision. Endoscopic mucosal resection has also been described in a few cases.4 This case confirms that endoscopic resection represents a safe and effective method for a definitive treatment of heterotopic gastric mucosa in the rectum. It should be considered as a first-line therapeutic strategy, leaving surgical resection only for those cases in which treatment fails.
- Garmendia M, Aparicio JR, Martinez J, et al. Heterotopic gastric mucosa in the rectum. Gastrointest Endosc 2007;65:921.[CrossRef][Medline]
- Devereaux CE, Devereaux RG. Heterotopic gastric mucosa of the rectum with a review of literature. J Clin Gastroenterol 1994;19:41–5.[CrossRef][Medline]
- Steele SR, Mullenix PS, Martin MJ, et al. Heterotopic gastric mucosa of the anus: A case report and review of the literature. Am Surg 2004;70:715–9.[Medline]
- Srinivasan R, Loewenstine H, Mayle JE. Sessile polypoid gastric heterotopia of the rectum: a report of 2 cases and review of the literature. Arch Pathol Lab Med 1999;123:222–4.[Medline]
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Gut 2008 57: 1192.[Extract] [Full Text] [PDF]
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