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Endoscopy 2013; 45(05): 397-400
DOI: 10.1055/s-0032-1326294
Case report/series
© Georg Thieme Verlag KG Stuttgart · New York

Severe upper gastrointestinal hemorrhage from linear gastric ulcers in large hiatal hernias: a large prospective case series of Cameron ulcers

M. Camus
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
3   Department of Gastroenterology, Lariboisière Hospital, APHP, University Paris 7, France
,
D. M. Jensen
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
2   Division of Digestive Diseases at UCLA Ronald Reagan Medical Center, Los Angeles, California, United States
4   Division of Digestive Diseases, Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California, United States
,
G. V. Ohning
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
2   Division of Digestive Diseases at UCLA Ronald Reagan Medical Center, Los Angeles, California, United States
4   Division of Digestive Diseases, Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California, United States
,
T. O. Kovacs
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
2   Division of Digestive Diseases at UCLA Ronald Reagan Medical Center, Los Angeles, California, United States
4   Division of Digestive Diseases, Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California, United States
,
K. A. Ghassemi
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
2   Division of Digestive Diseases at UCLA Ronald Reagan Medical Center, Los Angeles, California, United States
,
R. Jutabha
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
2   Division of Digestive Diseases at UCLA Ronald Reagan Medical Center, Los Angeles, California, United States
,
G. A. Machicado
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
2   Division of Digestive Diseases at UCLA Ronald Reagan Medical Center, Los Angeles, California, United States
4   Division of Digestive Diseases, Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California, United States
,
G. S. Dulai
1   CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
2   Division of Digestive Diseases at UCLA Ronald Reagan Medical Center, Los Angeles, California, United States
4   Division of Digestive Diseases, Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California, United States
,
O. J. Hines
5   Department of surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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submitted 29. August 2012

accepted after revision 04. Dezember 2012

Publikationsdatum:
24. April 2013 (online)

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We report a case series of all consecutive patients hospitalized in our two tertiary referral medical centers over the past 17 years for Cameron ulcers causing severe upper gastrointestinal hemorrhage (GIH) or severe obscure GIH. Cameron ulcers were diagnosed in 25 of the 3960 screened patients with severe upper GIH or severe obscure GIH (0.6 %). Of these, 21 patients had a prospective follow-up (median time 20.4 months [interquartile range: 8.5 – 31.8]). Patients were more often elderly women with chronic anemia, always had large hiatal hernias, and were usually referred for obscure GIH. Twelve of the 21 patients (57 %) were referred for surgery while being treated with high-dose proton pump inhibitors (PPIs). The other 9 patients (43 %) continued PPIs without any rebleeding during the follow-up. Cameron ulcers in large hiatal hernias are an uncommon cause of severe upper GIH. The choice of medical vs. surgical therapy should be individualized.

 

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