Hiatal hernia as a cause of obscure gi bleeding

Linear erosions occurring in gastric mucosa of large hiatal hernias have been correlated with the presence of iron deficiency anemia. They remain an often overlooked source of blood loss in pts undergoing evaluation for overt gastrointestinal bleeding. This is a retrospective analysis of 43 pts who were found to have hiatal hernia erosions during evaluation for obscure GI bleeding. These pts were identified from a database of 1200 pts undergoing push and sonde enteroscopy for evaluation of obscure GI bleeding between 1990-1995. Large hiatal hernias were defined as > 30% of the stomach above the diaphragmatic hiatus. These were found in 177/1200 pts (14.8%). 43/177 (24%) had erosions within the hiatus in the absence of any other enteroscopic findings. Pts with additional lesions such as intestinal vascular lesions were excluded. The 43 pts (19 M, 24 F) with average age 62 yrs (24-80) had been bleeding for an average of 33 mos (1-72) and had been transfused an average of 6.5 units prbc (0-38). Most pts had extensive prior evaluations, including multiple endoscopic exams, barium studies, bleeding scans, angiography in addition to push and sonde enteroscopy. A mean follow-up of 32 mos was obtained in 33/43 pts (75%). 7 pts had surgical repair of their hernias and 26 were treated medically with iron and anti-ulcer therapy. 2 medically treated pts had recurrent bleeding. Hiatal hernia erosions were identified as the only source of bleeding in 3.6% of pts with obscure GI bleeding. We conclude that hiatal hernia erosions are a cause of significant GI bleeding and should not be overlooked.