Gastric Heterotopia of The Duodenal Bulb: An Unusual Cause of Melena

Abstract

Gastric heterotopia (GH) is a rare congenital condition characterized by the presence of gastric mucosa outside its normal anatomical location. Although typically benign, GH can occur throughout the gastrointestinal tract and most frequently involves the duodenal bulb, where it often presents as polypoid lesions. Despite its rarity, GH should be considered in the differential diagnosis of polypoid gastrointestinal lesions associated with bleeding or obstructive symptoms, particularly in younger patients. We report the case of an 81-year-old man who presented with melena and intermittent epigastric pain. Esophagogastroduodenoscopy with biopsy revealed a polypoid lesion in the duodenum composed of heterotopic gastric mucosa, along with an associated esophageal hiatal hernia. The patient was managed with endoscopic resection of the lesion, followed by proton pump inhibitor therapy. The clinical course was favorable, with resolution of bleeding and no recurrence of symptoms during follow-up. This case highlights the diagnostic challenges of GH, particularly in elderly patients with                             atypical presentations, and underscores the importance of histopathological confirmation. Endoscopic management is both diagnostic and therapeutic, offering excellent outcomes. Clinicians should maintain awareness of this entity to ensure appropriate management and to avoid misdiagnosis with other potentially malignant lesions.