Back

P1314 - The Unseen Bleed: Does the Degree of Anemia Mirror Hiatal Hernia Size?

Monday, October 28

10:30 AM - 4:15 PM

Location: Exhibit Halls 3 and 4 (Street Level)

Award: Presidential Poster Award

Presenting Author(s)

Eric Lorio, MD

San Antonio, Texas

Eric Lorio, MD¹, Nicole Wisnewski², John A. Vizuete, MD, MPH³

¹University of Texas Health, San Antonio, TX; ²University of Notre Dame, San Antonio, TX; ³University of Texas Health Science Center, San Antonio, TX

Introduction: Multiple studies have established a relationship between esophageal hiatal hernias (HH) and iron deficiency anemia (IDA), often attributed to presence of Cameron lesions. Small hernias are often detected incidentally, and most do not lead to anemia. This study is designed to evaluate if size of hernia directly correlates with degree of anemia, particularly in very large hernias, a finding that could provide insight into the management of these patients in the future.

Methods: Electronic medical records from 5/2016 to 5/2019 were retrospectively reviewed. Patients with a diagnosis of iron deficiency anemia with complete endoscopic workup including EGD, colonoscopy, and complete small bowel capsule were included. Exclusion criteria included an alternative source for anemia such as celiac disease, peptic ulcer, or significant small bowel AVMs. Collected information included standard demographics, size of hiatal hernia, nadir hemoglobin (Hgb) during visit, presence or absence of Cameron lesions, and other capsule endoscopy findings.
Analysis of associations between hernia size at the time of capsule endoscopy and nadir Hgb was formulated using Pearson’s correlation testing. Graphic representation of results was depicted via linear regression modeling. Two-score T testing was also utilized to examine whether significant differences in degree of anemia exist between small (< 5 cm) and large (≥ 5 cm) hiatal hernias.

Results: 45 patients were included in the final dataset (78% women, 22% men). Only 7% (3/45) had visible Cameron lesions on upper endoscopy. Overall, degree of anemia did not correlate to size of hiatal hernia as Pearson’s correlation testing identified an r = -0.234 (p = 0.136). However, when controlling for hiatal hernias ≥ 5 cm, a statistically significant inverse relationship was noted between nadir hemoglobin levels and size of hiatal hernia, r = -0.362 (p = 0.041). Figure 1 summarizes these results. 2 score T-testing identified no significant difference in the mean nadir hemoglobin between small and large hiatal hernias, t = -0.029 (p = 0.488).

Discussion: A linear relationship between hernia size and degree of anemia appears to exist when esophageal hiatal hernias are 5 cm or larger, but even 3-4 cm hernias can result in significant iron loss. Clinicians should also be aware that Cameron lesions are not required to develop profound IDA. Our study is limited by sample size but offers some evidence that hernias larger than 5 cm should be considered for surgical repair.

Figure 1 depicts the inverse relationship between size of hiatal hernia and degree of anemia when controlling for all hernias ≥ 5 cm at the time of capsule endoscopy.

Figure 2: Shown are the correlation coefficients and confidence intervals for analyses of hiatal hernia size and degree of anemia. The categories represent the inclusion and exclusion of hernias with Cameron lesions, as well as the subgroups controlling for only hiatal hernias ≥ 5 cm. The average correlation coefficient amongst the above groups is also depicted. Despite only the HH ≥ 5 cm group being statistically significant, all bars land to the left of the midline, suggesting an overall trend towards an inverse relationship between hiatal hernia size and hemoglobin level.

Figure 3 shows the respective percentages of sampled patients who were found to have a Cameron lesion, a prior abdominal or thoracic surgery, an AVM, a hiatal hernia ≥ 5 cm, or a nadir Hgb <12 g/dL.

Disclosures:

Eric Lorio indicated no relevant financial relationships.

Nicole Wisnewski indicated no relevant financial relationships.

John Vizuete indicated no relevant financial relationships.

Citation: Eric Lorio, MD; Nicole Wisnewski; John A. Vizuete, MD, MPH. P1314 - THE UNSEEN BLEED: DOES THE DEGREE OF ANEMIA MIRROR HIATAL HERNIA SIZE?. Program No. P1314. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.