Large Hiatal Hernia and Iron Deficiency Anemia: Clinico-Endoscopical Findings

Abstract

We conclude that a hiatal hernia, with or without visible Cameron lesions, is a real and maybe underestimated cause of IDA. Finding a large hiatal hernia on upper endoscopy, together with a negative colonoscopy, completes the diagnostic work-up of IDA in most of these elderly patients. Currently, no guidelines concerning the optimal therapeutic management of this problem are available. Therapy may depend upon the need of transfusion, the efficiency of medical treatment, the risks of surgery and the preference and general condition of the patient.

Population with Large Hiatal Hernia: A Retrospective Analysis on Prevalence of Cameron Ulcers and Iron Deficiency Anaemia

“…Our overall prevalence of 8.5% significantly increased to 17.5% for those with HH size ≥ 6 cm, which is similar to an observation by Gray et al [5]. Association between iron deficiency anaemia and Hiatal hernia has been described in literature [9,10]. In our study, more than 50% of the population with hiatal hernia were found to be anaemic (Hg <12), and with our strict exclusion criteria for other causes of anaemia, they are more likely to be iron deficient unless proven otherwise.…”

Cameron Lesions: Unusual Cause of Gastrointestinal Bleeding and Anemia

“…Erosions in the form of Cameron lesions can cause iron deficiency from chronic blood loss. However, Panzuto et al [10] and Pauwelyn and Verhamme [11] demonstrated that a large hiatal hernia could cause iron deficiency anemia, even without Cameron lesions.…”

“…However, it should be noted that endoscopic hemostasis is difficult in such scenarios due to anatomic and technical reasons [18]. Surgical treatment (fundoplication – laparoscopic or open) is recommended in patients with medically refractory disease [11, 19], uncontrolled bleeding from the lesions and in patients in whom the hernia is complicated with volvulus, incarceration and perforation [4]. Endoscopic plication is a novel and emerging treatment option for patients with GERD and hiatal hernia [20, 21].…”

Diaphragmatic hernia presenting as gastrointestinal bleeding

“…A review of the literature revealed one such study in which the authors described three children, all of whom had an acute presentation and had to be operated on an emergency basis (5). Late presentation of diaphragmatic hernia as anemia has been described in adults (2).The cause of anemia has been attributed to Cameron lesions which are linear gastric ulcers or erosions on the mucosal folds at the diaphragmatic impression in patients with a large hiatal hernia (6,7). These gastric erosions can cause iron deficiency anemia from chronic blood loss.…”

“…Potential complications such as gastrointestinal bleeding (acute, chronic and obscure) and anemia make the condition clinically relevant (1). There are many studies describing adult patients with diaphragmatic hernia presenting with anemia (2)(3)(4). However, diaphragmatic hernia with intermittent gastric volvulus and gastrointestinal bleeding resulting in persistent iron-deficiency anemia has never been described in a child.…”