From the Research
Cameron ulcers are erosions or ulcerations that occur in a hiatal hernia where the stomach protrudes through the diaphragm into the chest, and the most effective treatment involves a combination of acid suppression therapy and addressing the underlying hiatal hernia, with first-line treatment being proton pump inhibitors (PPIs) such as omeprazole 20-40mg daily or pantoprazole 40mg daily for 8-12 weeks, followed by maintenance therapy 1.
Definition and Pathogenesis
Cameron ulcers typically develop at the point where the stomach slides through the diaphragmatic hiatus, causing mechanical trauma and ischemia to the gastric mucosa. They are often associated with large hiatal hernias and can cause chronic blood loss leading to iron deficiency anemia.
Diagnosis and Treatment
Diagnosis of Cameron ulcers can be challenging, and they are often overlooked at endoscopy, leading to repeated and unnecessary diagnostic procedures 2. Treatment involves a combination of acid suppression therapy and addressing the underlying hiatal hernia.
- First-line treatment is proton pump inhibitors (PPIs) such as omeprazole 20-40mg daily or pantoprazole 40mg daily for 8-12 weeks, followed by maintenance therapy.
- For patients with bleeding or anemia, higher doses may be needed.
- Sucralfate 1g four times daily can provide additional mucosal protection.
- H2 receptor antagonists like famotidine 20mg twice daily can be used as alternatives for those who cannot tolerate PPIs.
- Surgical repair of the hiatal hernia may be necessary for patients with persistent symptoms or recurrent bleeding despite medical therapy.
Complications and Surveillance
Cameron ulcers can cause chronic blood loss leading to iron deficiency anemia, which may require iron supplementation (ferrous sulfate 325mg three times daily) 3. Regular endoscopic surveillance is recommended to monitor healing and prevent complications. The choice of medical vs. surgical therapy should be individualized for each patient, taking into account the size of the hernia sac, the presence of concomitant acid-peptic diseases, and the patient's overall health status 4.