ORIGINAL ARTICLE Prevalence and Resolution of Anemia with Paraesophageal Hernia Repair Chady Haurani & Arthur M. Carlin & Zane T. Hammoud & Vic Velanovich Received: 2 April 2012 / Accepted: 6 July 2012 / Published online: 28 July 2012 # 2012 The Society for Surgery of the Alimentary Tract Abstract Background Paraesophageal hernias may produce a variety of clinical sequelae including anemia and esophagogastric ulcerations or erosions. We examined the prevalence of anemia in patients with paraesophageal hernias and frequency of anemia resolution with hernia repair. Methods Patients undergoing paraesophageal hernia repairs from July 1996 to September 2010 were included. Data gathered included age, gender, type of hernia, presence of symptomatic anemia, presence of esophagogastric ulcer/erosion, type of repair, and anemia resolution. Results One hundred eighty-three patients underwent paraesophageal hernia repair; of these, 68 (37 %) were anemic. Of these anemic patients, 39 (57 %) were symptomatic from their anemia or specifically referred for anemia, and 20 (29 %) had esophagogastric ulceration/erosion. Fifty-eight had documented follow-up. Overall, of these, 35 (60 %) had resolution of their anemia. Seventy percent of symptomatic patients had resolution of their anemia, compared to 48 % of asymptomatic patients (p 0 0.1). Of patients with esophagogastric ulceration/erosion, 85 % were symptomatic and 88 % had resolution of anemia, compared to 50 % of patients without ulceration/erosion (p 0 0.015). Conclusions Anemia was a common finding in patients with paraesophageal hernia and most patients were symp- tomatic because of their anemia. Those patients with esophageal or gastric ulceration/erosion were very likely to have symptomatic anemia, and, interestingly, these patients were more likely to have their anemia resolve with paraesophageal hernia repair. Keywords Paraesophageal hernia . Anemia . Esophageal ulcer . Gastric ulcer . Erosion Introduction Diaphragmatic hiatal hernias may produce a variety of clin- ical sequelae. The association between hiatal hernias and anemia has long been recognized. 1,2 Paraesophageal hernias (types II–IV), in which herniation of the gastric fundus through the esophageal hiatus occurs alongside the lower esophagus, account for approximately 5 % of all hiatal hernias. 3 Anemia has been shown to be three times more frequent in patients with the true paraesophageal variety as compared to the more common sliding type of hiatal hernia (type I). 4 The cause of this anemia has been attributed to linear ulcerations or erosions on the gastric mucosal folds at or near the level of the diaphragm. 4,5 In fact, the American Gastroenterology Association lists these so called Cameron's erosions in large hiatal hernias as a This study was a poster presentation of the Society for Surgery of Alimentary Track during the Digestive Disease Week (DDW®), May 2011, Chicago, IL. C. Haurani : A. M. Carlin (*) : Z. T. Hammoud Department of Surgery, Henry Ford Health System, 2799 West Grand Blvd., Detroit, MI 48202, USA e-mail: acarlin1@hfhs.org V. Velanovich Division of General Surgery, University of South Florida, One Tampa General Circle, F145, Tampa, FL 33606, USA J Gastrointest Surg (2012) 16:1817–1820 DOI 10.1007/s11605-012-1967-6