What is Cameron Lesions?
A gastrointestinal bleed, or a bleed within the digestive system, is the most common reason for hospital admissions related to stomach or digestion issues. Roughly half of these cases are due to upper gastrointestinal bleeding which refers to bleeding in the upper parts of your digestive system – the esophagus, stomach or the first part of the small intestine. Common reasons for this include peptic ulcers (sores in the stomach lining), varices in the esophagus or stomach (abnormally large veins), esophagitis (inflammation of the esophagus), angioectasia (abnormal blood vessels), and vascular lesions (damaged blood vessels). However, for about 8% of cases, the cause is not known.
Cameron lesions, though rare, can also cause upper gastrointestinal bleeding. These are open sores or damage to the stomach lining found where the stomach is impressed or indented by the diaphragm (the muscle under your lungs that helps you breathe), in patients with a large hiatal hernia (where the upper part of the stomach bulges through the diaphragm). These lesions, first identified by Cameron and Higgins in 1986, were found in people whose chest X-ray showed one-third or more of the stomach above the diaphragm. In half of the recorded cases, people were found to be anemic (having low iron levels in the blood).
What Causes Cameron Lesions?
Cameron lesions, which are abnormalities in the stomach, can be caused by a variety of factors. The most common cause is physical damage from constant friction between folds of stomach lining near the diaphragm’s constriction point. This friction happens due to movements of the stomach during breathing, such as the stomach moving upwards, changes in chest pressure pushing outwards and upwards, and pinching pressure from the “crura” (bands of fibrous tissue) when the stomach moves through the diaphragm.
Other ways Cameron lesions can occur include an injury from stomach acid, a lack of blood supply to the herniated sac due to pressure from the diaphragm, and swelling of the gut wall because of a blockage in the veins, leading to slowed blood flow.
It’s important to note that there doesn’t seem to be a connection between Cameron lesions and the use of non-steroidal anti-inflammatory drugs (NSAIDs), infection with Helicobacter pylori bacteria, or not using proton-pump inhibitors (PPIs), which are a type of medicine for heartburn. However, some research has linked binge drinking with Cameron lesions.
Risk Factors and Frequency for Cameron Lesions
Hiatal hernia is a condition that can be found in about 0.8 to 2.9 percent of all patients who undergo an upper gastrointestinal endoscopy. 5% of patients known to have hiatal hernia may also present with Cameron lesions, as seen during these endoscopies.
Cameron lesions can naturally heal within a few days, which might result in them not being reported often. The likelihood of having these lesions is directly linked with the size of the hiatal hernia. Hiatal hernia frequency increases with age, hence the majority of cases occur in older adults. These cases are rare in children, with the youngest patient being only three years old. Moreover, females are more likely to have this ailment compared to males.
Most of these cases are reported in developed countries like North America and Western Europe. Fewer cases are reported in Africa, but this might be because of underreporting. There has been no identified relationship with environmental aspects or genetics in relation to this condition. However, studies suggest that insufficient fiber intake and a high sitting position during bowel movement could potentially increase the risk of developing Cameron lesions.
Signs and Symptoms of Cameron Lesions
Cameron lesions are a possible explanation for hidden blood loss in the upper part of the digestive tract. This can sometimes cause iron deficiency anemia. Symptoms of this condition include fatigue, a pale complexion, blood in the stool, heart palpitations, or shortness of breath during physical activity.
These issues are more commonly connected to larger hernias (greater than 3 cm), than smaller ones (under 3 cm), as the size of the lesions grows with the size of the hernia. Patients might also have discomfort in the upper central part of the stomach area, similar to when one has gastroesophageal reflux disease (GERD). In rare cases, patients can experience an openly glaring, possibly life-threatening gastrointestinal bleed.
Cameron lesions are conditions that can be related to hidden blood loss in the upper part of the digestive system, sometimes resulting in iron deficiency anemia. Signs of this might include being tired, looking pale, having blood in your stool, feeling your heart beat hard or fast, or feeling out of breath when you exercise.
- Tiredness
- Pale complexion
- Blood in stool
- Rapid heartbeat
- Shortness of breath during physical activity
These symptoms are usually more related to larger hernias (greater than 3 cm in size) than to smaller ones (less than 3 cm), because the bigger the hernia, the bigger the lesion. Patients may also experience discomfort in the upper central part of the abdomen, similar to the sensation of acid reflux. In rare situations, there can be an openly visible and life-threatening gastrointestinal bleed.
Testing for Cameron Lesions
Cameron lesions can be hard for doctors to diagnose. A person with this condition may have blood tests that show they’re low on iron and have anemia, which means they have a lower-than-normal number of red blood cells. These tests might show lower than normal levels of iron and ferritin (a protein that stores iron in your body), and higher than normal total iron-binding capacity, which measures how well your body can transport iron in the blood.
One way to potentially spot a Cameron lesion is through an x-ray of the chest. This method might help to see a hiatal hernia, which is when part of your stomach pushes up into your chest. This looks like a large structure in the back part of your chest. Another, non-invasive way to diagnose a hiatal hernia is through a barium swallow. This is when you swallow a liquid that helps your doctor see your esophagus, stomach, and small intestine on an x-ray. The hiatal hernias can usually be seen on these x-rays, but the Cameron lesions may not be visible.
Endoscopy is the best way to diagnose Cameron lesions. In this procedure, a thin tube with a light and camera on the end is inserted into your mouth and down into your stomach, allowing your doctor to look at your digestive tract. However, Cameron lesions can sometimes be overlooked due to their location. They are often not found on the first endoscopy and are usually only spotted on later ones. The doctor will have to carefully look at the surrounding region and the hiatal hernia during the endoscopy. They will look for symptoms such as redness, swelling, bruising and bleeding, along with the Cameron lesions in the stomach lining. These lesions usually appear as linear erosions, often surrounded by red borders.
New tests like magnification chromoendoscopy might also be useful in diagnosing these lesions. This method of endoscopy uses dyes to enhance the contrast of areas in your digestive tract, making it easier to see any abnormalities. It’s especially helpful when the lesions are not well defined. However, the usefulness of capsule endoscopy, a procedure where you swallow a capsule with a mini camera inside, hasn’t yet been fully confirmed. Given that the procedure is more expensive and the camera moves through your system quickly, it’s unlikely to be the top method chosen for diagnosis.
Treatment Options for Cameron Lesions
There are several treatment options for conditions like these, including medications, surgery, and special procedures called endoscopic interventions. From a medicinal perspective, doctors typically prescribe medications to reduce stomach acid, known as Proton Pump Inhibitors (PPIs), which help to heal the damaged areas faster. Additionally, iron supplements are often provided if the patient is also suffering from iron deficiency anemia.
Typically, most patients dealing with these sorts of issues are already managing an existing acid-related health problem (like acid reflux or inflammation of the esophagus) and are therefore already using acid-inhibitors. This combination of medicines has shown promising results by encouraging healing and stabilizing hemoglobin, a protein carrying oxygen in the blood.
Sometimes, a procedure known as endoscopic band ligation might be necessary. In this procedure, the doctor stops active bleeding by using a band to tie off the blood vessels. While this method has been successful in a few cases, it isn’t always possible due to the structure and layout of the affected area. Other methods, like the use of heat (cauterization) or injecting a drug called epinephrine, have also been used in some situations to temporarily improve conditions.
Surgery can be another option for patients, particularly when the bleeding isn’t responsive to other treatments or if the hernia (when an organ pushes through an opening in the muscle or tissue that holds it in place) gets worse with complications like entrapment, volvulus (twisting), or even perforation. From a surgical standpoint, one option is fundoplication, which is the wrapping of the upper part of the stomach around the lower end of the esophagus to prevent acid from flowing back into the esophagus. Considering the close relationship between hernias in the upper part of the stomach (hiatal hernias) and the occurrence of Cameron lesions – small, linear tears or erosions on the inner lining of the esophagus – fundoplication is often a reasonable method of treatment.
What else can Cameron Lesions be?
When diagnosing a Cameron lesion, which is a condition where the stomach lining erupts through a hiatal hernia, doctors need to consider ruling out several other conditions. These conditions show similar symptoms and must be differentiated based on the patient’s age, overall health, and other health problems they may have. The conditions to consider include:
- Telangiectasias – an abnormal dilation in the capillaries, arteries, or veins.
- Ulcers – open sores that develop on the inside lining of your stomach and the upper part of your small intestine.
- Esophagitis – inflammation that may damage tissues of the esophagus, the muscular tube that delivers food from your mouth to your stomach.
- Mallory-Weiss tear – a tear in the lining of your esophagus, the tube that carries food from your throat to your stomach.
- Diverticulosis – a condition where small bulging pouches develop in the digestive tract.
- Dieulafoy lesion – a rare condition, which can cause gastrointestinal bleeding.
- Neoplasms – also known as tumors, which can be benign or malignant.
Doctors usually use endoscopy, a procedure used to examine a person’s digestive tract, to help in diagnosing these conditions accurately.
What to expect with Cameron Lesions
Medical treatment often results in excellent outcomes. This includes using acid inhibitors and iron supplements, which often show good healing effects within 6 weeks. However, there have been some instances where complications occur. This can be seen in continuing anemia or instances of rebleeding.
Most patients who do not respond well to medical treatment may continually lose blood and end up needing multiple blood transfusions.
When medical treatment doesn’t work, surgery is usually the next step. A specific surgical procedure known as a fundoplication is commonly used. This surgical approach has shown to be successful, with no recurring ulcers or instances of severe bleeding during the recovery period.
Possible Complications When Diagnosed with Cameron Lesions
The diagnosis can often be missed because the signs are not specific, which can lead to delayed treatment and negative health effects. The most severe complication is spontaneous bleeding if the condition is not treated. Other complications can include worsening iron deficiency anemia. This can cause instability in blood flow and deteriorate any pre-existing health conditions if severe.
Common Consequences:
- Missed diagnosis due to non-specific signs
- Delayed treatment
- Negative health effects
- Severe spontaneous bleeding if untreated
- Worsening iron deficiency anemia
- Instability in blood flow
- Deterioration of pre-existing health conditions
Preventing Cameron Lesions
To lower their risk, patients should make some lifestyle changes. These include not drinking alcohol, avoiding fried and fatty foods, and avoiding exercises that put pressure on the stomach area. Regular check-ups with their main doctor to monitor their lab results, and with a specialist called a gastroenterologist to track how things are going, are also necessary.
