What is the most likely diagnosis?
a) HP associated gastritis
b) Gastric CMV infection
c) Cameron's ulceration
d) Gastric amyloidosis
e) Linitus plastica
These are Cameron ulcers first described by Cameron and Higgins in 1986 (presumably in a post-mortem series?). They are typically seen in at the site of large hiatal hernias. Although most may well be asymptomatic, the classical association is with iron deficiency anemia.
The exact pathogenesis is not known but the location suggests that it has something to do with the "to-and-fro" motion of the stomach through the diaphragmal hiatus. There is no particular association with HP infection. For these reasons, this type of ulceration may not improve with PPI therapy. Nevertheless, empirical treatment would be with PPI therapy and (if indicated) iron supplementation. In a study by Moskovitz et.al (Am J Gastroenterol 1992;87:622–626), 64% of cases healed with H2 blockers and presumably PPI therapy is even more effective. Surgical repair, although curative, is not always possible as most patients are elderly.