Original Article

Clinical Characteristics and Evaluation of Patients with Large Hiatal Hernia and Cameron Lesions

Authors: Mustafa Yakut, MD, Gökhan Kabaçam, MD, Ayşegül Öztürk, MD Irfan Soykan, MD

Abstract

Objectives: Cameron lesions are located at the neck of large hiatal hernias, and are associated with anemia or overt gastrointestinal (GI) bleeding. The aim of this study was to investigate the clinical and endoscopic properties of patients with Cameron lesions.


Methods: Eighteen patients were diagnosed as having large hiatal hernia and Cameron lesions. Patients with Cameron lesions (n = 18) were compared to patients with large hiatal hernias without Cameron lesions (n = 26), by means of presenting symptoms and endoscopic findings.


Results: The mean age of patients with Cameron lesions was significantly higher than patients without Cameron lesions (71.1 ± 11.63 vs 56.7 ± 17.4 years, P = 0.005). The ratio of female patients with Cameron lesions was higher compared to patients with large hiatal hernia without Cameron lesions (14/18 [77.7%] vs 12/26 [46.1%], P = 0.00). While 12 of 18 patients with Cameron lesions had overt GI bleeding, none of the patients with large hiatal hernia without Cameron lesions had signs of GI bleeding. Fifteen of 18 patients had ulcers in the hernia sac and the others had linear erosions. There was no significant difference between patients with and without Cameron lesions by means of hemoglobin levels (11.1 ± 2.20 vs 12.2 ± 2.5 g/dL, P = 0.157).


Conclusion: Most patients with large hiatal hernia and Cameron lesions presented with overt GI bleeding. Patients with Cameron lesions tend to be older females. In patients with anemia and GI bleeding, large hiatal hernia and Cameron erosions should also be considered.


Key Points


* Patients with large hiatal hernias (LHH) may have proximal gastric ulcer or erosion, termed Cameron ulcer at the level of the hiatus.


* These ulcers are usually asymptomatic and are found incidentally, but may cause occult or overt gastrointestinal bleeding and anemia.


* In patients with anemia and gastrointestinal bleeding, large hiatal hernia and Cameron erosions/ulcers should also be considered, especially in elderly patients.

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References

1.Maganty K, Smith RL. Cameron lesions: unusual cause of gastrointestinal bleeding and anemia. Digestion 2008;77:214–217.
 
2. Rabine JC, Nosrant TT. Miscellaneous diseases of the stomach, in Yamada T (ed): Textbook of Gastroenterology. West Sussex, United Kingdom, Blackwell Publishing, 2009, pp 1071–1084.
 
3. Gisbert JP, Blanco M, Mateos JM, et al. H pylori-negative duodenal ulcer prevalence and causes in 774 patients. Dig Dis Sci 1999;44:2295–2302.
 
4. Lin CC, Chen TH, Ho WC, et al. Endoscopic treatment of a Cameron lesion presenting as life-threatening gastrointestinal hemorrhage. J Clin Gastroenterol 2001;33:423–424.
 
5. Cameron AJ, Higgins JA. Linear gastric erosion. A lesion associated with large diaphragmatic hernia and chronic blood loss anemia. Gastroenterology 1986;91:338–342.
 
6. Weston AP. Hiatal hernia with cameron ulcers and erosions. Gastrointest Endosc Clin N Am 1996;6:671–679.
 
7. Cameron AJ. Incidence of iron deficiency anemia in patients with large diaphragmatic hernia. A controlled study. Mayo Clin Proc 1976;51:767–769.
 
8. Panzuto F, Di Giulio E, Capurso G, et al. Large hiatal hernia in patients with iron deficiency anaemia: a prospective study on prevalence and treatment. Aliment Pharmacol Ther 2004;19:663–670.
 
9. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol 2008;22:601–616.
 
10. Khusun H, Yip R, Schultink W, et al. World Health Organization hemoglobin cut-off points for the detection of anemia are valid for an Indonesian population. J Nutr 1999;129:1669–1674.
 
11. Hocking BV, Alp MH, Grant AK. Gastric ulceration within hiatus hernia. Med J Aust 1976;2:207–208.
 
12. Pauwelyn KA, Verhamme M. Large hiatal hernia and iron deficiency anaemia: clinico-endoscopical findings. Acta Clin Belg 2005;60:166–172.
 
13. Fireman Z, Zachlka R, Abu Mouch S, et al. The role of endoscopy in the evaluation of iron deficiency anemia in premenopausal women. Isr Med Assoc 2006;88–90.
 
14.Grande M, Cadeddu F, Villa M, et al. Helicobacter pylori and gastroesophageal reflux disease. World J Surg Oncol 2008;6:74.
 
15. Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 1999;94:2840–2844.
 
16. Pandolfino JE, El-Serag HB, Zhang Q, et al. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 2006;130:639–649.
 
17. Bayyurt N, Abasiyanik MF, Sander E, et al. Canonical analysis of factors involved in the occurrence of peptic ulcers. Dig Dis Sci 2007;52:140–146.
 
18. Ha NR, Lee HL, Lee OY, et al. Differences in clinical characteristics between patients with non-erosive reflux disease and erosive esophagitis in Korea. J Korean Med Sci 2010;25:1318–1322.
 
19. Zagari RM, Fuccio L, Wallander MA et al. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett's oesophagus in the general population: the Loiano–Monghidoro study. Gut 2008;57:1354–1359.
 
20. Moschos J, Pilpilidis I, Kadis S, et al. Cameron lesion and its laparoscopic management. Indian J Gastroenterol 2005;24:163.