PWE-179 Cameron lesions as a cause of acute upper gastrointestinal bleeding and iron deficiency anaemia

Abstract

Introduction Cameron lesions are linear corrosions or ulcers in gastric folds of the diaphragmatic part in patients with a large sliding hiatal hernia. They are found in about 5% of the patients with a known hiatal hernia and are subjected to upper GI endoscopy. Multiple possible causes have been reported such as mechanical trauma and exposure to acids or ischemia on a local vascular level. Cameron lesions are usually responsible for chronic blood loss and iron deficiency anaemia. Method In a period of two years (2012–2013) the data of all patients who were hospitalised for acute upper gastrointestinal (GI) bleeding or examined on regular basis for iron deficiency anaemia were reviewed. The cases with Cameron lesions during upper GI endoscopy and considered as the main cause of haemorrhage or anaemia were analysed concerning demographics, clinical characteristics and treatment. Results The data of 434 patients with acute upper GI bleeding (180 cases) or iron deficiency anaemia (254 cases) were analysed. 21 patients (4,8%, 10 males and 11 females) with Cameron lesions were identified, aged between 50–91 years (95% CI 63.1–72.9, median age 68 years). Clinical presentation was melaena (8 patients) haematemesis (4 patients) and iron deficiency anaemia (8 patients). 8 patients reported NSAID’s use. The size of the hiatal hernia ranged from 2 to 10 cm (95% CI 4–6, median diameter 5 cm), while the ulcer diameter ranged from 0.7 to 2 cm (median diameter 1.2 cm). Hemostasis was performed in 2 patients (adrenaline, clips) and all cases received PPI treatment. In all patients the lesions were found at the first esophagoduodenoscopy. No relapse of acute GI bleeding was reported on follow up. Conclusion Apart from iron deficiency anaemia, Cameron lesions may be responsible for acute upper GI bleeding. They should be sought in patients with a hiatal hernia where no other cause of haemorrhage or anaemia can be found. Disclosure of interest None Declared.