Heterotopic Gastric Mucosa in Middle Esophagus Complicated with Esophageal Ulcers

Heterotopic gastric mucosa (HGM) of esophagus, primarily occurring in cervical esophagus, is usually asymptomatic. A healthy woman (mid-40s) with postprandial heartburn was diagnosed with middle esophageal HGM and esophageal ulcers by esophagogastroduodenoscopy. Using 8-channel pH monitoring, a sensor near the HGM area detected postprandial acid phase (pH 3-4), while areas adjacent to the proximal and distal sensors were neutral, suggesting acid secretion from the HGM. A biopsy showed fundic gland tissue expressing H⁺/K⁺-ATPase and pepsinogen-I. Oral vonoprazan improved the clinical symptoms and endoscopic findings. This is the first report using 8-channel pH monitoring to diagnose extremely rare middle esophageal HGM.     

Steuerliche Einordnung der wirtschaftlichen Vorteile aus einer Vertragsarztzulassung

Abstrakt  Der wirtschaftliche Vorteil einer Vertragsarztzulassung stellt kein gesondert zu bewertendes Wirtschaftsgut dar, sondern einen wertbildenden Faktor des Wirtschaftsguts “Praxiswert” im Rahmen des Gesamtkaufpreises zum Erwerb der Vertragsarztpraxis.