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Review
. 2021 Mar 27;13(3):222-230.
doi: 10.4240/wjgs.v13.i3.222.

Paraesophageal hernia and iron deficiency anemia: Mechanisms, diagnostics and therapy

Christoph G Dietrich  1 , Dolores Hübner  2 , Joachim W Heise  3
Affiliations
Review

Paraesophageal hernia and iron deficiency anemia: Mechanisms, diagnostics and therapy

Christoph G Dietrich et al. World J Gastrointest Surg. .

Abstract

There is ample clinical evidence suggesting that the presence of large axial or paraesophageal hernias may lead to iron deficiency anemia. So-called Cameron lesions, as well as other small mucosa erosions, in the sliding area of these diaphragmatic hernias lead to invisible chronic blood loss and consequently to iron depletion. While the spectrum of symptoms in these patients is large, anemia is often not the only indication and typically not the primary indication for surgical correction of diaphragmatic hernias. Drug treatment with proton pump inhibitors and iron substitution can alleviate anemia, but this is not always successful. To exclude other possible bleeding sources in the gastrointestinal tract, a comprehensive diagnostic program is necessary and reviewed in this manuscript. Additionally, we discuss controversies in the surgical management of paraesophageal hernias.

Keywords: Cameron lesions; Iron deficiency anemia; Paraesophageal hernia; Upside-down stomach.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
In the hiatal hernia itself, the so-called Cameron lesions are repeatedly referred to as macroscopic correlates of bleeding activity. A: Typical fibrin-coated Cameron lesions; B: Atypical bleeding lesions with coarsening of the mucosal relief and redness.
Figure 2
Figure 2
Differences in the size and extension of a hernia. A: Gastroscopically small sliding hernia; B: Significantly larger hernia (mixed type) on diagnostic computed tomography for the same patient.
Figure 3
Figure 3
Three-dimensional presentation of an upside-down stomach. A: Axial view; B: Frontal view; C: Lateral view.
Figure 4
Figure 4
Laparoscopic repair of a large paraesophageal hernia type III (mixed type). A: Wide open hiatus esophagei with displaced stomach. The left liver lobe is uplifted; B: View into the mediastinum; C: After preparation of both diaphragmatic edges; D: Hiatoplasty using double-stitched nonabsorbable sutures; E: After completion of hiatoplasty; F: Relocalized stomach without tension in the abdomen.
See this image and copyright information in PMC

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