A 30-year-old diagnosis

Correct answer: c.

Discussion

These lesions are Cameron ulcers, which were first described by Cameron and Higgins in 1986.¹ Cameron ulcers are typically seen at the site of large hiatal hernias. Although most individuals with Cameron ulcers may well be asymptomatic, the classic association of the lesions is with iron deficiency anaemia.

The exact pathogenesis of Cameron ulcers is not known, but the location suggests that it has something to do with the ‘to-and-fro’ motion of the stomach through the diaphragmatic hiatus. There is no particular association with Helicobacter pylori infection.

For these reasons, this type of ulceration may not improve with proton pump inhibitor (PPI) therapy. Nevertheless, empiric treatment would be with PPI therapy and (if indicated) iron supplementation. In a study by Moskovitz et al., 64% of cases healed with H₂ blockers; presumably PPI therapy would be even more effective.² Naturally, a surgical repair would be curative. However, this is not a common treatment as most patients are elderly.