Q: I am a 26 years old man who had severe acidity problem for 6 months, around 4 years back. After a year I developed some pain and swelling at the back of my neck. An endoscopy revealed a small red patch and the report stated it as ectopic gastric mucosa. A biopsy sample was taken, which was sent for diagnosis and revealed heterotopic gastric mucosa. My gasteroenterologist suggested not to bother and did not advise any further investigations. Now after every few months I feel some pain or rather irritation while eating, which lasts a few days and then settles down. Why is it happening and what is its treatment?

A:Your recurrent pain high up in the gullet as well as the fact you have suffered with heartburn suggests to me that you have reflux of stomach acid into the gullet from time to time. It is possible that your symptoms could have been negligible for a long time and this is not uncommon in this condition although it is unusual to have an isolated area high up in the gullet. It is right that you have had an endoscopy and biopsy. The fact that you have gastric type of mucosa in the gullet is not normal and is always considered to be due to long standing reflux, and you need treatment for this by the latest available antacid therapy and the treatment needs to be continued for a long time and annual endoscopy and biopsies from the area. Commonly this type of epithelium arises in the lower part of the gullet just above the junction of the stomach and oesophagus. You also need an oesophageal manometry to study if there is actual reflux or is it a congenital patch and therefore you need to consult an appropriate gastroenterologist for these investigations as well as annual biopsies from the area to ensure that it continues to remain benign.