Dietrich CG, Hübner D, Heise JW. Paraesophageal hernia and iron deficiency anemia: Mechanisms, diagnostics and therapy. World J Gastrointest Surg 2021; 13(3): 222-230 [PMID: 33796212 DOI: 10.4240/wjgs.v13.i3.222]
Corresponding Author of This Article
Christoph G Dietrich, MD, PhD, Chief Doctor, Department of Internal Medicine, Bethlehem Center of Health, Bethlehem-Gesundheitszentrum Stolberg/Rhld, Steinfeldstr 5, Stolberg D-52222, Germany. dietrich@bethlehem.de
Research Domain of This Article
Surgery
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2021; 13(3): 222-230 Published online Mar 27, 2021. doi: 10.4240/wjgs.v13.i3.222
Paraesophageal hernia and iron deficiency anemia: Mechanisms, diagnostics and therapy
Christoph G Dietrich, Dolores Hübner, Joachim W Heise
Christoph G Dietrich, Department of Internal Medicine, Bethlehem Center of Health, Stolberg D-52222, Germany
Dolores Hübner, Department of Radiology, Bethlehem Center of Health, Stolberg D-52222, Germany
Joachim W Heise, Department of General and Abdominal Surgery, Bethlehem Health Center, Stolberg D-52222, Germany
Author contributions: Dietrich CG developed the concept of this review, and all authors contributed to the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christoph G Dietrich, MD, PhD, Chief Doctor, Department of Internal Medicine, Bethlehem Center of Health, Bethlehem-Gesundheitszentrum Stolberg/Rhld, Steinfeldstr 5, Stolberg D-52222, Germany. dietrich@bethlehem.de
Received: December 30, 2020 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 Processing time: 77 Days and 22.4 Hours
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.
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.
