Cameron Lesions

Cameron lesions are linear erosions or ulcerations on the gastric mucosa at the level of the diaphragmatic hiatus, found exclusively in patients with a hiatal hernia. They occur in roughly 5% of patients with hiatal hernias and become more common as hernia size increases. The lesions are thought to arise from mechanical trauma (the hernia sliding back and forth across the diaphragm) compounded by ischemia and acid exposure.

Clinically, Cameron lesions are a frequently missed cause of iron-deficiency anemia and obscure GI bleeding, particularly in older adults. Overt bleeding is unusual; chronic occult blood loss is the rule. Endoscopic recognition requires deliberate inspection of the hernia sac with the scope partially withdrawn : the lesions are easy to miss when the focus is on the lower esophagus or on retroflexion.

Management combines proton pump inhibitor therapy, iron repletion, and treatment of the underlying hiatal hernia. Refractory bleeding or large symptomatic hernias may warrant surgical hiatal hernia repair.