P4109 - Iron Deficiency Anemia With a Negative Endoscopic Workup: The Hidden Hand of Cameron Lesions

Binyamin R. Abramowitz, MD¹, Bani Chander-Roland, MD, FACG², Sonny Caceres, MD³, Promila Banerjee, MD, FACG⁴, Ayse Aytaman, MD, FACG⁵, Daniel A. DiLeo, MD^5
1SUNY Downstate Health Sciences University, New York, NY; ²VA NY Harbor Health System Clinical Associate Professor SUNY Downstate Health Sciences University, Brooklyn, NY; ³SUNY Downstate Medical Center, Brooklyn, NY; ⁴Edward Hines Jr. Veterans Affairs Hospital, Loyola University Chicago Stritch School of Medicine, Maywood, IL; ⁵Brooklyn VA Medical Center, Brooklyn, NY

Introduction: American Gastroenterological Association (AGA) guidelines recommend bidirectional endoscopy for evaluation of iron deficiency anemia (IDA). However, when endoscopic evaluation is unrevealing, patients are often left with no known etiology for their IDA. As up to 42% of all patients with hiatal hernias have a known diagnosis of IDA, it has been hypothesized that Cameron lesions, or linear erosions within the mucosal folds of the diaphragmatic impression in patients with hiatal hernias, may be an elusive etiology in these patients. As there is a paucity of data within the literature on the topic, our study sought to evaluate the prevalence of significant hiatal hernias within IDA patients with a negative endoscopic workup to shed light on the role of Cameron lesions within IDA.

Methods: We performed a retrospective chart review including all patients who underwent bidirectional endoscopy for IDA with unrevealing findings between October 2021 and December 2023 at the Brooklyn VA Hospital. We also chart reviewed all patients who underwent esophagogastroduodenoscopy (EGD) for all indications other than IDA between June and December 2023 at the Brooklyn VA to serve as a control group. Demographic and clinical information across the two population cohorts was collected, compared, and analyzed. A significant hiatal hernia was defined as those measuring 2 centimeters or larger.

Results: A total of 107 patients were included in our study; 53 patients in the negative IDA workup cohort and 54 patients in the control group. While there were no statistically significant differences in the sex, age, racial, or ethnic makeup of the two cohorts, IDA patients with a negative endoscopic workup were significantly more likely to be found with hiatal hernias than their non-IDA counterparts (47.2% vs 27.8%, p=0.038).

Discussion: Studies within the literature have shown the prevalence of hiatal hernias within the general population undergoing EGD to be between 25-30%, similar to the 27.8% we found within our control group. As 47.2% of IDA patients with a negative endoscopic workup were found to have significant hiatal hernias, our data supports the notion that hiatal hernias and the Cameron lesions they contain may play a significant role in IDA, especially in patients with a negative endoscopic workup. Larger prospective studies are warranted to provide further support for the role of hiatal hernias and Cameron lesions within IDA.


Disclosures:


Binyamin R. Abramowitz, MD¹, Bani Chander-Roland, MD, FACG², Sonny Caceres, MD³, Promila Banerjee, MD, FACG⁴, Ayse Aytaman, MD, FACG⁵, Daniel A. DiLeo, MD⁵. P4109 - Iron Deficiency Anemia With a Negative Endoscopic Workup: The Hidden Hand of Cameron Lesions, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.