Esophageal Pancreatic Acinar Heterotopia: Premalignant or Benign

Dysphagia, which refers to difficulty swallowing, can be caused by benign pathologies of the esophagus such as gastroesophageal reflux disease which is the most common cause. There are also malignant pathologies such as esophageal carcinoma which should be excluded during the initial clinical evaluation of a patient. Esophageal pancreatic acinar heterotopia (EPAH) is an exceedingly rare finding and an uncommon differential for dysphagia. A search of the literature yielded few previously reported cases. In general, the reported prevalence of pancreatic acinar heterotopia ranges from 16% to 24% in asymptomatic patients and 3% in patients with a known history of Barrett’s esophagitis. It has been found in patients ranging from as young as 1 day old to an incidental autopsy finding. Here, we present a brief literature review and a case of a 57-year-old man with severe dysphagia who was discovered to have EPAH in the gastroesophageal junction, associated with active inflammation and focal metaplasia.