{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:15:22Z","timestamp":1790000122659,"version":"4.0.1"},"reference-count":33,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Objectives: Cameron lesions are linear gastric erosions or ulcers that develop at the level of the diaphragmatic constriction within a hiatal hernia. They represent an underrecognized cause of chronic iron-deficiency anemia and upper gastrointestinal bleeding. This study aimed to characterize the demographic, clinical, endoscopic, and therapeutic features of Cameron lesions diagnosed at a tertiary referral digestive endoscopy center in the Republic of Moldova. Methods: This was a retrospective single-center study from Republic of Moldova conducted over a 9-year period (2017\u20132026). Forty-three consecutive patients with endoscopically confirmed Cameron lesions were included. All examinations were performed by a single experienced endoscopist using high-definition endoscopy systems (Olympus EVIS Exera III and Olympus EVIS X1). Demographic characteristics, hiatal hernia type and size, clinical presentation, endoscopic findings, bleeding stigmata, Helicobacter pylori status, and postoperative outcomes were analyzed. Results: The mean age of the patients was 60.4 years (range, 31\u201383 years), with a female predominance (65.1%; 28 women and 15 men). The distribution of hiatal hernia types was as follows: type I (axial\/sliding), 32.6% (n = 14); type II (paraesophageal\/rolling), 34.8% (n = 15); and type III (mixed), 32.6% (n = 14). Cameron lesions developed after failed fundoplication in three patients (6.9%) and were identified in fixed (39.5%), completely reducible (16.3%), and partially reducible (mixed) hernias (44.2%). The main indications for upper gastrointestinal endoscopy were GERD symptoms (53.4%), iron-deficiency anemia (20.9%), prophylactic or postoperative surveillance (18.6%), and overt upper gastrointestinal bleeding (7.0%). Active Cameron lesions were identified in 55.8% of patients, whereas cicatricial and mixed lesions accounted for 30.2% and 13.9%, respectively. Bleeding stigmata were classified according to Forrest as Ia (2.3%), Ib (18.6%), IIa (4.65%), IIb (11.6%), IIc (7.0%), and III (55.81%). Nine patients (20.9%) were identified with active bleeding. Importantly, Cameron lesions were also identified in small hiatal hernias (&lt;3 cm) and in patients with recurrent hiatal hernia after failed fundoplication. Helicobacter pylori infection was detected in 25.6% (n = 11) of patients. Conclusions: This study confirms the well-established association between Cameron lesions, female sex, hiatal hernias, and gastrointestinal bleeding while providing several novel observations, including their occurrence in small hiatal hernias, diagnosis in relatively young adults, and recurrence following failed fundoplication. The findings also highlight the potential contribution of the reducible component of hiatal hernias to lesion development and emphasize the importance of meticulous inspection of the hernia sac during every upper gastrointestinal endoscopic examination.<\/jats:p>","DOI":"10.3390\/diagnostics16183051","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3051","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cameron Lesions: Endoscopic Characteristics, Clinical Profile, and Therapeutic Implications\u2014A Retrospective Study of 43 Patients"],"prefix":"10.3390","volume":"16","author":[{"given":"Viorel","family":"Istrate","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Nicolae Testemi\u021banu State University of Medicine and Pharmacy, MD-2004 Chisinau, Moldova"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Alex-Claudiu","family":"Moraru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of General and Esophageal Surgery, Sf. 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StatPearls [Internet], StatPearls Publishing."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1159\/000144281","article-title":"Cameron lesions: Unusual cause of gastrointestinal bleeding and anemia","volume":"77","author":"Maganty","year":"2008","journal-title":"Digestion"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"102333","DOI":"10.1016\/j.gassur.2026.102333","article-title":"Hiatal hernia and anemia: A single-center experience","volume":"30","author":"Shah","year":"2026","journal-title":"J. Gastrointest. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1007\/s11605-013-2184-7","article-title":"Iron-deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair","volume":"17","author":"Carrott","year":"2013","journal-title":"J. Gastrointest. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/S0022-5223(96)70149-6","article-title":"Diaphragmatic hernia and associated anemia: Response to surgical treatment","volume":"112","author":"Trastek","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"bcr0620103129","DOI":"10.1136\/bcr.06.2010.3129","article-title":"Cameron lesions: An often-overlooked cause of iron deficiency anaemia in patients with large hiatal hernias","volume":"2010","author":"Kimer","year":"2010","journal-title":"BMJ Case Rep."},{"key":"ref_8","first-page":"639","article-title":"Cameron lesion with severe iron deficiency anemia and review of literature","volume":"13","author":"Singhai","year":"2022","journal-title":"Casp. J. Intern. Med."},{"key":"ref_9","first-page":"479240","article-title":"Transfusion-Dependent Anaemia: An Overlooked Complication of Paraoesophageal Hernias","volume":"2014","author":"Skipworth","year":"2014","journal-title":"Int. Sch. Res. Not."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.clinre.2018.05.002","article-title":"Cameron lesions: A still overlooked diagnosis. Case report and systematic review of literature","volume":"42","author":"Zullo","year":"2018","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/00004836-200111000-00018","article-title":"Endoscopic treatment of a Cameron lesion presenting as life-threatening gastrointestinal hemorrhage","volume":"33","author":"Lin","year":"2001","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"A27","DOI":"10.1016\/j.cgh.2019.08.049","article-title":"Upper Gastrointestinal Bleeding due to Cameron Lesions","volume":"18","author":"Pereira","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.giec.2015.02.009","article-title":"Unusual Causes of Upper Gastrointestinal Bleeding","volume":"25","author":"Parikh","year":"2015","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_14","first-page":"e7644","article-title":"Cameron Ulcers: Rare Case of Overt Upper Gastrointestinal Bleed in a Patient with Alcohol Use Disorder","volume":"12","author":"Mehershahi","year":"2020","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4959","DOI":"10.3748\/wjg.v18.i35.4959","article-title":"Cameron ulcers: An atypical source for a massive upper gastrointestinal bleed","volume":"18","author":"Kapadia","year":"2012","journal-title":"World J. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S0025-6196(25)05232-2","article-title":"Incidence of iron deficiency anemia in patients with large diaphragmatic hernia. A controlled study","volume":"51","author":"Cameron","year":"1976","journal-title":"Mayo Clin. Proc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e246496","DOI":"10.1136\/bcr-2021-246496","article-title":"Black oesophagus, upside-down stomach and cameron lesions: Cascade effects of a large hiatal hernia","volume":"14","author":"Deliwala","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1097\/XCS.0000000000001040","article-title":"Updated Markov Model to Determine Optimal Management Strategy for Patients with Paraesophageal Hernia and Symptoms, Cameron Ulcer, or Comorbid Conditions","volume":"238","author":"DeMeester","year":"2024","journal-title":"J. Am. Coll. Surg."},{"key":"ref_19","first-page":"e50678","article-title":"Cameron Lesions with Severe Anemia: A Case Report","volume":"15","author":"Cardona","year":"2023","journal-title":"Cureus"},{"key":"ref_20","first-page":"e65510","article-title":"A Case of Cameron Lesions: An Overlooked Cause of Anemia in Patients with Gastrointestinal Bleeding and Hiatal Hernia","volume":"16","author":"Le","year":"2024","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3072","DOI":"10.1007\/s00464-019-07054-9","article-title":"Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair","volume":"34","author":"Addo","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_22","first-page":"6010","article-title":"Gastroesophageal flap valve status distinguishes clinical phenotypes of large hiatal hernia","volume":"16","author":"Kaneyama","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_23","first-page":"16","article-title":"A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion","volume":"1","author":"Ozaydin","year":"2014","journal-title":"Am. J. Exp. Clin. Res."},{"key":"ref_24","first-page":"398","article-title":"Life-threatening bleeding for a large cameron ulcer. A novel description of a tailored-surgical strategy: Report of a case and literature overview","volume":"40","author":"Bisogni","year":"2019","journal-title":"G. Chir."},{"key":"ref_25","first-page":"e73131","article-title":"Symptomatic Anemia Due to Cameron Lesions: A Case Report","volume":"16","author":"Girgis","year":"2024","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/S1052-5157(18)30334-9","article-title":"Hiatal hernia with Cameron ulcers and erosions","volume":"6","author":"Weston","year":"1996","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1111\/dote.12223","article-title":"Cameron lesions in patients with hiatal hernias: Prevalence, presentation, and treatment outcome","volume":"28","author":"Gray","year":"2015","journal-title":"Dis. Esophagus"},{"key":"ref_28","first-page":"622","article-title":"Large hiatal hernias, anemia, and linear gastric erosion: Studies of etiology and medical therapy","volume":"87","author":"Moskovitz","year":"1992","journal-title":"Am. J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1177\/1066896912446947","article-title":"Histopathological characterization of a Cameron lesion","volume":"20","author":"Katz","year":"2012","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/SMJ.0b013e31820c018c","article-title":"Clinical characteristics and evaluation of patients with large hiatal hernia and Cameron lesions","volume":"104","author":"Yakut","year":"2011","journal-title":"South. Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1055\/s-0032-1326294","article-title":"Severe upper gastrointestinal hemorrhage from linear gastric ulcers in large hiatal hernias: A large prospective case series of Cameron ulcers","volume":"45","author":"Camus","year":"2013","journal-title":"Endoscopy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"222","DOI":"10.4240\/wjgs.v13.i3.222","article-title":"Paraesophageal hernia and iron deficiency anemia: Mechanisms, diagnostics and therapy","volume":"13","author":"Dietrich","year":"2021","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"7154","DOI":"10.1007\/s00464-020-08135-w","article-title":"Surgical management of hiatal hernia vs. medical therapy to treat bleeding Cameron lesions: A systematic review and meta-analysis","volume":"35","author":"Verhoeff","year":"2021","journal-title":"Surg. Endosc."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3051\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:23:22Z","timestamp":1789997002000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":33,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16183051"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16183051","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]}}}