Introduction Giant Paraesophageal hiatal hernias (PEH) are most commonly associated with symptoms of chest pain, early satiety and GERD. However, Iron-deficiency anaemia is an under-appreciated condition associated with giant PEH. The aim of this study was to evaluate the incidence of iron-deficiency anaemia in a cohort of patients with giant PEH and assess the incidence of resolution associated with operative PEH repair.
Methods Between 2000 and 2010, 270 patients underwent operative repair of PEH and were prospectively entered into an IRB-approved database. From this cohort, 123 (45.6%) patients demonstrated a pre-existing diagnosis of iron-deficiency anaemia. 77 patients had a documented pre-operative haemoglobin level (Hb) consistent with iron-deficiency anaemia and a follow-up Hb level at least 3 months following surgery and constituted the study population.
Results From the cohort of 77 patients with documented pre-operative iron-deficiency anaemia, 72 (94%) underwent elective PEH repair, with a median age was 75 (range 39–91). Cameron erosions were endoscopically documented preoperatively in 25 patients (32%). The average preoperative Hb value was 11.8 (7.6–16). Postoperatively at 3–12 month follow-up, the average Hb level was 13.2 (10.7–17), and at more than 1 year follow-up it was 13.6 (9.2–17.2) (p<0.05). Furthermore 90% of patients had a rise in post-operative haemoglobin level by at least 1 g/dl. Anaemia was fully resolved postoperatively (Hb≥12.0 in females, ≥14.0 in males) in 55 (71%) patients. This resolution was observed more commonly in women (40/50, 80%) than men (15/27, 56%, p<0.05). Also younger patients (<70 years) were more likely to resolve their anaemia (29/33 vs 26/44; p<0.05) and have a greater post-operative Hb (14.0 vs 13.0 g/dl; p<0.05) than older patients. 40 patients required preoperative iron supplementation, 29 (73%) were able to discontinue iron following surgery. There was no significant difference in the resolution of anaemia in patients with or without Cameron erosions (19/25 vs 36/52, p=0.54).
Conclusion This single institution study shows a high incidence of iron-deficiency anaemia (45.6%) in patients with giant PEH. Elective repair results in resolution of the anaemia and discontinuation of iron supplementation therapy, in more than 70% of patients. This improvement in Hb is independent of the presence of pre-operative Cameron erosions. This study demonstrates the clinical and potential economic benefits of elective PEH repair of patients with Giant PEH and iron-deficiency anaemia.
Competing interests None declared.
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