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

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

Core Tip: Large axial or paraesophageal hernias may cause iron deficiency anemia, but the detailed mechanisms, necessary diagnostic procedures and therapeutic possibilities are not completely clear and have not been standardized. This review summarizes the knowledge regarding these aspects in an often-neglected cause of anemia, especially in older patients.