This 78 year old man was referred for evaluation of iron deficiency anemia and occult blood in the stool. He had a history of diverticulosis and prostate cancer status post proton beam therapy. A colonoscopy showed diverticulosis and no evidence of radiation proctopathy or angiodysplasia.
On upper endoscopy this large sliding hiatal hernia is seen. Careful inspection reveals these linear erosions on the crests of the gastric folds overlying the diaphragmatic indentation.
These erosions called Cameron ulcers and are the characteristic lesions that may be seen in patients with large hiatal hernias and iron deficiency anemia. They are typically linear, superficial and non-bleeding. Their appearance may be quite subtle and are often missed unless looked for specifically.
Cameron erosions were first described by Cameron and Higgins in 1986. These authors studied a series of 109 patients with large hiatal hernias and found that 39 had linear erosions at the diaphragmatic impression. There was a significant association between the presence of these erosions and anemia. The pathophysiology of these erosions is not known, but they have been postulated to result from mechanical trauma, ischemia, or acid mucosal injury. Cameron erosions are thought to be one cause of chronic occult gastrointestinal blood loss; less commonly, they may present with acute gastrointestinal bleeding. There is no consensus on the optimal management of these lesions. Medical therapy includes iron supplementation and acid suppression. Some patients with refractory, transfusion-dependent anemia due to Cameron erosions have responded to surgical hiatal hernia repair.
Andrew Tai, MD, PhD, Massachusetts General Hospital