Cameron lesions in patients with hiatal hernias: prevalence, presentation, and treatment outcome

Abstract

Background and study aims Cameron lesions, as defined by erosions and ulcerations at the diaphragmatic hiatus, are found in the setting of gastrointestinal (GI) bleeding in patients with a hiatus hernia (HH). The study aim was to determine the epidemiology and clinical manifestations of Cameron lesions. Patients and methods This is a retrospective cohort study evaluating consecutive patients undergoing upper endoscopy over a two year period. Endoscopy reports were systematically reviewed to determine presence or absence of Cameron lesions and hiatus hernia. Inpatient and outpatient records were reviewed to determine prevalence, risk factors, and outcome of medical treatment of Cameron lesions. Results Of 8260 upper endoscopic examinations, 1306 (20.2%) reported a HH. When categorized by size, 65.6% of HH were small (<3 cm), 23.0% moderate (3-4.9 cm) and 11.4% were large (≥5 cm). Of these, 43 patients (mean age 65.2 years, 49% female) had Cameron lesions, with a prevalence of 3.3% in the presence of HH. Prevalence was highest with large HH (12.8%). On univariate analysis, large HH, frequent NSAID use, GI bleeding (both occult and overt) and nadir hemoglobin level were significantly greater with Cameron lesions compared to HH without Cameron lesions (p≤0.03). Large HH size and NSAID use were identified as independent risk factors for Cameron lesions on multivariate logistic regression analysis. Conclusions Cameron lesions are more prevalent in the setting of large HH and NSAID use, can be associated with GI bleeding, and can respond to medical management.

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

“…We also found that the prevalence of Cameron ulcers increases with size of HH. 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].…”

“…Other hypothesized factors include mucosal ischemia/mucosal injury from acid reflux/NSAID use [1,5,6]. From our study, we found that large hiatal hernias are significantly associated with Cameron ulcer in the multivariate analysis; other factors such as NSAID/anticoagulant use/H.…”

Cameron Ulcers: Rare Case of Overt Upper Gastrointestinal Bleed in a Patient with Alcohol Use Disorder

“…Overall prevalence of Cameron lesions in all EGD's is less than 1% [6]. In a study by Camus et al of 3960 endoscopies, Cameron lesions were found only in 0.6% cases [7]. They are found in 5.2% of all hiatal hernias on EGD [8].…”

“…Their prevalence increases with the size of the hiatal hernia. Gray et al classified hiatal hernia according to size as follows: small (<3 cm), medium (3-4.9 cm) and large (>/=5 cm) [7]. Of all the Cameron lesions they found, 23.2% occurred in small, 32.6% occurred in medium and 44.2% occurred in large hiatal hernias.…”

“…Among obscure GI bleeders the prevalence is around 3.8% [7]. In obscure GI bleeding, the following possibilities exist: the lesion is within the reach of the EGD and was missed, lesion is within the reach of the EGD and is hidden (beneath mucosal folds) or intermittently present (Dieulafoy's lesion) and lesion is out of the reach of the EGD (in small intestine).…”