eP547 - Heterotopic Gastric Mucosa in the Anorectal Region: A Unique Case with Helicobacter Pylori Infection

Purpose/Background: Heterotopic gastric mucosa (HGM) has been described in various parts of the gastrointestinal tract but is a rare entity in the anorectal region. The majority of these patients are asymptomatic and are diagnosed incidentally. HGM in the anorectal region can manifest with non-specific abdominal symptoms such as pain, bloating and nausea, or anorectal complaints such as pruritus ani, tenesmus and hematochezia. The presence of Helicobacter pylori in HGM has been previously reported. We report our unique case with anorectal HGM and H. Pylori infection.Methods/Interventions: A middle-aged Caucasian male with a past medical history of familial mediterranean fever presented to the gastroenterology clinic with complaints of intermittent bouts of low volume bright red bleeding per rectum. He had regular bowel movements at baseline with no previous episodes of rectal bleeding. Physical and digital rectal exams were normal. He underwent colonoscopy that revealed a 4 mm polyp at the anorectal junction. The polyp was removed using cold biopsy forceps. Pathologic evaluation of the polyp revealed a pyloric gland adenoma arising from the heterotopic gastric tissue within anorectal mucosa. No dysplasia was seen. H. pylori bacteria was identified in close association with epithelium on the immunohistochemical stain. His H. pylori breath test was positive. Enzyme immunoassay detected H. pylori antigen in his stool. He was started on metronidazole, doxycycline, bismuth subsalicylate and omeprazole. His antibiotics were changed to levofloxacin and amoxicillin due to an attack of familial mediterranean fever during the therapy.Results/Outcomes: After he completed 14 days of treatment, his symptoms resolved and the repeat H. pylori breath test was negative. The patient has recovered well with no recurrence of rectal bleeding to date.Conclusion/

Discussion: Heterotopic gastric mucosa in the anorectal region is a rare pathologic finding that typically presents as a sessile polyp and can occasionally be associated with H. pylori colonization. It is hypothesized that these bacteria may have passed along the length of the gastrointestinal tract to colonize the hindgut. The inflammation associated with H. Pylori infection can result in complications like ulceration, bleeding, perforation or malignancy. It is important to recognize and treat this condition properly. Management strategies include surgical or endoscopic removal of the HGM, and treatment of H. Pylori infection."Heterotopic gastric tissue on microscopic examiantion

Examination showed rectal mucosa with heterotopic gastric tissue (arrows) of mixed oxyntic type (A.) and non-oxyntic type (B.) glands with overlying foveolar epithelium.
Pyloric gland adenoma

A polypoid proliferation of tightly packed tubular glands lined by single layer of columnar epithelium with basal nuclei and clear cytoplasm. No dysplasia seen.
Helicobacter pylori

Helicobacter pylori micro-organisms were seen closely associated with the foveolar epithelium (arrows) on the hematoxylin and eosin stain (A) and H.pylori immunohistochemical stain (B). "