Published online Mar 27, 2021. doi: 10.4240/wjgs.v13.i3.222
Peer-review started: December 30, 2020
First decision: January 18, 2021
Revised: January 23, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: March 27, 2021
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.
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.