Rectal Gastric heterotopia associated with Helicobacter pylori; a case report

February 27, 2024

2,838 2 minutes read

Presented in 13th World Gastroenterology, IBD & Hepatology Conference in Holiday Inn Dubai, Al Barsha, UAE & Virtual from December 15-17, 2023.

Speaker Name: Dr Saeed Ahmed – Digestive diseases centre, University Hospitals of Leicester, East Midlands (United Kingdom)
Dr Saeed Ahmed¹, Professor John De Caestecker¹, Dr Sanjeev Pattni¹

Introduction:
Lower GI tract gastric heterotopic mucosa (GHT) is rare and the aetiology remains unclear.
GHT is a condition in which the gastric mucosa is discovered elsewhere. GHT in lower GI
tract is uncommon and literature review shows that predominant locations include
oesophagus, and duodenum; it can rarely present like a Meckel’s diverticulum.
Rectal GHT is rare and literature search has shown around 50 case reports. Only a few have
shown colonisation of Helicobacter pylori, which can be associated with the usual
associations of Helicobacter pylori such as inflammatory change, ulceration and potential
neoplasia, such as MALT lymphoma and colorectal cancer; the latter can sometimes lead to
intermittent rectal bleeding.
Case presentation:
We present a case of 56-year-old lady who attended for a flexible-sigmoidoscopy as part of
the Bowel Scope programme. Her sigmoidoscopy, revealed a 10mm raised area in the
rectum, near the anal verge, with an unusual pit pattern appearance.
She was subsequently referred for a completion colonoscopy and potential EMR
polypectomy; the Bowel Cancer Screening colonoscopist took biopsies from the lower rectal
polyp as he felt that this was not an adenomatous polyp; the histopathological analysis
showed a mixture of normal large bowel mucosa and gastric phenotype contiguous with each
other; there was mild patchy chronic inflammation with no evidence of dysplasia or
malignancy; there were a small number of curvilinear rod shaped organisms seen trapped in
the surface suggestive of Helicobacter pylori. These findings were confirmed with the aid of
immunohistochemistry.
Discussion:
Heterotopic gastric mucosa (HGM) has been described throughout the gastrointestinal tract.
However predominantly reported in upper GI tract commonly oesophagus and duodenum.
Historically aberrant gastric mucosa was described as early as 1939 but to date the reported
cases remains rare 1 . Though HGM of upper GI tract could be upto 13% in one study the
finding in large bowel is rare 2 . The heterotopic gastric mucosa can present clinically in a
variety of ways but commonly related to gastric tissue acid production, commonly rectal
bleeding. The rectal presentations the endoscopic features range from a solitary ulcer, flat
polyp and in some cases adenocarcinoma has been reported 3 .

References:
1. Aberrant gastric mucosa in the rectum with ulceration and hemmorhage. Wis Med J1939;38:641-643
2. Heterotopic gastric mucosa of the gastrointestinal tract: prevalence, histological features, and clinical
characteristics. Scand J Gastroenterol. 2014;49:138–144.
3. Heterotopic gastric mucosa mimicking a rectal submucosal tumor. Endoscopy 2015; 47 Suppl 1: E329-E330
4. Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. Digestive Disease and Sciences, 2012 Aug; 57(8): 2184-94