title: Iron-deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair.
abstract: BACKGROUND
  A significant percentage of patients with paraesophageal hernia (PEH) will have a co-existing diagnosis of iron-deficiency anemia which will resolve following surgical repair.
  
  
  METHODS
  Between 2000 and 2010, 270 patients underwent operative repair of PEH. Of this group, 123 patients (45.6 %) reported a preexisting diagnosis of iron-deficiency anemia. The study group consisted of 77 patients with a documented preoperative hemoglobin level (Hb) consistent with iron-deficiency anemia and a follow-up level at least 3 months following surgery.
  
  
  RESULTS
  Of the 77 patients included, 72 underwent elective repair, median age was 75 (39-91) years, and 65 % were female. Cameron erosions were identified preoperatively in 32 %. Mean preoperative hemoglobin was 9.6 (4.4-13.6) g/dl and postoperative hemoglobin was 13.2 (10.7-17) g/dl at 3-12 months and 13.6 (9.7-17.2) g/dl at more than 1 year. Ninety percent of patients had a rise in postoperative hemoglobin level by at least 1 g/dL. Anemia resolved in 55 (71 %) patients, more often in women and younger patients (<70 years). Twenty-nine of 40 (73 %) patients on iron therapy discontinued this postoperatively.
  
  
  CONCLUSIONS
  A significant number of patients who present with giant PEH will present with iron-deficiency anemia. Elective repair will result in resolution of the anemia in more than 70 % of patients. PEH is underappreciated as a source of iron-deficiency anemia, and appropriate patients should be considered for elective repair.
authors.affiliation: Section of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA.
authors.forename: Philip W
authors.initials: PW
authors.lastname: Carrott
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Jean
authors.initials: J
authors.lastname: Hong
authors.forename: Madhan Kumar
authors.initials: MK
authors.lastname: Kuppusamy
authors.forename: Richard P
authors.initials: RP
authors.lastname: Koehler
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome