Journal of Hepatology and Gastrointestinal disorders
Open Access

Abstract

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

Dennisdhilak Lourdusamy

Background and Aim: Hiatal hernia (HH) is reported to occur more commonly than previously thought with increase in number of endoscopies. Association of hiatal hernia with iron deficiency anaemia (IDA) is long reported, however there is inadequate literature on the actual factors contributing to the anaemia, including the role of Cameron ulcers and esophagitis. Our aim was to analyse the prevalence of Cameron ulcers in large HH and various factors that could attribute to anaemia in large HH.

Methods: We retrospectively analysed 117 patients (inpatient population) with large hiatal hernia (axial size ≥ 4 cm) between Jan 2008 to Sept 2015 at Monmouth Medical Centre, after excluding those with other chronic causes of anaemia. Various factors were analysed including the prevalence of Cameron ulcers, overall prevalence of anaemia, and other demographic and endoscopic details. All statistical analyses were performed using the survey commands in STATA MP 11.0.

Results: A total of 117 patients were included in the final analysis. The mean patient age was 71.1 years with a female predominance (65%). The mean size of the HH was 5.71 cm. In about 50% of the population the indication for endoscopy was Gastrointestinal (GI) bleed or anaemia or both. About 65% of the population was found to have iron deficiency anaemia. Overall prevalence of Cameron ulcers in our population was 8.5%, which increased to 17.5% with those HH ≥ 6 cm which was statistically significant (p=0.04). Esophagitis was found in 28.2% of the population. The prevalence of anaemia (<12 g/dl) in those with esophagitis was marginally higher than those without esophagitis in our study at 53.1% (17/32) and 52% (39/75) respectively, after adjusting for the presence of Cameron ulcers which was not statistically significant. There was no significant association between the use of NSAIDS/H pylori and the prevalence of Cameron ulcers in both univariate and multivariate analysis.

Conclusion: Large HH (size ≥ 4 cm) has a strong association with iron deficiency anaemia in more than 50% of the population. Cameron ulcers are found only in a minority of population (<10%), with increasing prevalence with increase in size of HH. NSAIDS/H pylori don’t appear to influence the prevalence of Cameron ulcers in HH. Esophagitis appears to have a role in contribution to chronic blood loss anaemia, even though there was no statistical significance in our study. Future large prospective studies could provide additional insight into this.