From the Research
Surgical management is the most effective treatment for Cameron ulcers, with a therapeutic success rate of 92% compared to 67.2% for medical treatment with proton pump inhibitors (PPIs) 1. The treatment of Cameron ulcers typically involves addressing the underlying cause of the ulcer, which is often related to a hiatal hernia.
- Medical treatment with PPIs such as omeprazole 20-40mg daily or pantoprazole 40mg daily for 8-12 weeks can be effective in healing the ulcer.
- However, for patients with recurrent or severe cases, surgical repair of the hiatal hernia may be required.
- Iron supplementation (ferrous sulfate 325mg three times daily) is necessary to correct anemia caused by chronic blood loss from the ulcer.
- Cameron ulcers develop due to mechanical trauma and ischemia at the diaphragmatic hiatus, where the stomach repeatedly slides and rubs against the diaphragm during normal breathing and movement.
- Regular endoscopic follow-up is important to ensure healing and prevent recurrence. The most recent and highest quality study on this topic, a systematic review and meta-analysis published in 2021, found that surgical management was associated with a significantly higher therapeutic success rate compared to medical treatment 1. Key points to consider in the treatment of Cameron ulcers include:
- The size of the hiatal hernia, with larger hernias (>5cm) being more likely to require surgical repair.
- The presence of H. pylori infection, which may require triple therapy with a PPI and two antibiotics.
- The patient's overall health status and ability to undergo surgery.
- The risk of complications from surgery, such as bleeding or infection.