An unusual cause of Gastric ulceration?

October 02, 2011 By: Bjorn Rembacken

This was found in an elderly patient investigated for an iron deficiency anaemia.

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.

About the author

Bjorn Rembacken is at Leeds Teaching Hospitals NHS Trust, Leeds, UK. He was born in Sweden and qualified from Leicester University in 1987. He undertook his postgraduate education in Leicester and in Leeds. His MD was dedicated to inflammatory bowel disease. Dr Rembacken was appointed Consultant Gastroenterologist, Honorary Lecturer at Leeds University and Endoscopy Training Lead in 2005. Follow Bjorn on Twitter @Bjorn_Rembacken

 

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