Duodenal gastric heterotopia: further evidence of an association with fundic gland polyps

Duodenal gastric heterotopia (DGH) is a common incidental finding at endoscopy, generally assumed to be congenital in origin. A recent study has suggested a possible association with gastric fundal gland polyps (FGPs). In this review of 37 patients with histologically confirmed DGH, the background to our present understanding of the DGH lesion is reviewed, the clinical and pathological associations of the condition in our cohort are identified, and the histological and immunohistochemical features of the DGH lesion are described. An association with the presence of FGPs is again demonstrated, whereas an inverse relationship with Helicobacter pylori is also shown. Immunohistochemical staining demonstrates that the fundic-type glands of DGH express the proton pump antigen (H(+)K(+)ATPase), whereas the overlying surface mucosa expresses the mucin profile of normal gastric-type mucosa (mucin-5AC positive, mucin-2 negative). DGH may represent a further component of the iatrogenic hypergastrinemia-related hypothesis for FGP development, although further study is required to confirm this.