title: Severe upper gastrointestinal hemorrhage from linear gastric ulcers in large hiatal hernias: a large prospective case series of Cameron ulcers.
abstract: We report a case series of all consecutive patients hospitalized in our two tertiary referral medical centers over the past 17 years for Cameron ulcers causing severe upper gastrointestinal hemorrhage (GIH) or severe obscure GIH. Cameron ulcers were diagnosed in 25 of the 3960 screened patients with severe upper GIH or severe obscure GIH (0.6 %). Of these, 21 patients had a prospective follow-up (median time 20.4 months [interquartile range: 8.5 - 31.8]). Patients were more often elderly women with chronic anemia, always had large hiatal hernias, and were usually referred for obscure GIH. Twelve of the 21 patients (57 %) were referred for surgery while being treated with high-dose proton pump inhibitors (PPIs). The other 9 patients (43 %) continued PPIs without any rebleeding during the follow-up. Cameron ulcers in large hiatal hernias are an uncommon cause of severe upper GIH. The choice of medical vs. surgical therapy should be individualized.
authors.affiliation: CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States. marine.camus@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Camus
authors.forename: D M
authors.initials: DM
authors.lastname: Jensen
authors.forename: G V
authors.initials: GV
authors.lastname: Ohning
authors.forename: T O
authors.initials: TO
authors.lastname: Kovacs
authors.forename: K A
authors.initials: KA
authors.lastname: Ghassemi
authors.forename: R
authors.initials: R
authors.lastname: Jutabha
authors.forename: G A
authors.initials: GA
authors.lastname: Machicado
authors.forename: G S
authors.initials: GS
authors.lastname: Dulai
authors.forename: O J
authors.initials: OJ
authors.lastname: Hines
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D005260:Female; D018662:Fundoplication; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D059485:Gastropexy; D005773:Gastroscopy; D006551:Hernia, Hiatal / Q000150:complications* / Q000628:therapy*; D006801:Humans; D057194:Intention to Treat Analysis; D007501:Iron / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D013276:Stomach Ulcer / Q000150:complications* / Q000628:therapy*
chemical_list: D054328:Proton Pump Inhibitors; D007501:Iron