What are Cameron's erosions (gastric mucosal erosions)?

From the Guidelines

Cameron erosions should be treated with proton pump inhibitors (PPIs) such as omeprazole 20-40 mg daily to heal the erosions, as they are a common cause of obscure gastrointestinal bleeding in patients with large hiatal hernias. According to the american gastroenterological association (aga) institute medical position statement on obscure gastrointestinal bleeding 1, Cameron’s erosions are one of the commonly overlooked lesions in the upper GI tract that can cause bleeding. These erosions are linear gastric erosions or ulcerations that occur at the diaphragmatic hiatus in patients with large hiatal hernias.

• Treatment typically involves PPIs for 8-12 weeks to heal the erosions, and for maintenance therapy, once-daily PPI or H2-receptor antagonists may be used.
• Patients should avoid NSAIDs, alcohol, and smoking which can worsen erosions, as stated in the study 1.
• Surgical repair of the hiatal hernia may be considered for patients with recurrent bleeding or those who don't respond to medical therapy.
• Cameron erosions develop due to mechanical trauma from the diaphragm rubbing against the herniated stomach and acid-induced injury at the hiatus, and they often present with iron deficiency anemia due to chronic, slow blood loss.
• Patients with Cameron erosions should have regular monitoring of hemoglobin levels and may require iron supplementation (ferrous sulfate 325 mg three times daily) to correct anemia, as the study 1 highlights the importance of identifying and treating the underlying cause of bleeding.

From the Research

Definition and Prevalence of Cameron Erosions

• Cameron erosions, also known as Cameron lesions, are erosive-ulcerative alterations of the gastric mucosa that occur in patients with large hiatal hernias, potentially causing gastrointestinal bleeding and iron deficiency anemia 2.
• The prevalence of Cameron lesions has been reported to be around 5-9.2% in patients with iron deficiency anemia 2.
• These lesions are often overlooked at endoscopy, leading to repeated and unnecessary diagnostic procedures, particularly in patients with chronic anemia 2.

Clinical Presentation and Diagnosis

• The most frequent presenting symptoms of Cameron lesions are anemia (62%) and overt gastrointestinal bleeding (36%) 2.
• Patients with Cameron lesions often undergo one or more previous upper endoscopy before the diagnosis is achieved, with as many as 69% of patients having undergone previous endoscopy 2.
• The diagnosis of Cameron lesions can be challenging, and the lesions can be easily confused with ischemic gastritis on histopathological examination 3.

Treatment and Management

• Patients with Cameron lesions are mainly treated with proton pump inhibitor (PPI) therapy and iron supplementation 2.
• Endoscopic hemostasis is performed in around 10% of cases, and blood transfusion is required in around one-third of cases 2.
• Surgical management, such as hiatal hernia repair, is also an option, with studies suggesting that it can be effective in resolving Cameron lesions and improving therapeutic success 4.
• A systematic review and meta-analysis found that surgical management was associated with therapeutic success, with 92% of patients having resolution of Cameron lesions, compared to 67.2% for those treated with PPIs 4.

Comparison of Treatment Options

• A study comparing PPIs and histamine-2 receptor antagonists found that PPIs were superior in preventing recurrent ulcers/erosions in low-dose aspirin users 5.
• Another study found that omeprazole was effective in acute healing and maintenance of erosive or worse esophagitis, and was significantly better than H2 receptor antagonists 6.