Esophageal Hiatus Hernia Associated with Hypochromic Anemia and Angina Pectoris

Abstract

The association of esophageal hiatus hernia with severe hypochromic anemia has been reported by a number of observers^{1, 2, 3, 4, 5, 6}. The anemia is due to loss of blood from the gastro-intestinal tract, probably the result of congestion or erosion of the gastric mucosa proximal to the constricting ring of the hernia. In the case reported by Schiro and Benjamin⁶, however, gastroscopic examination revealed no erosions and no differences in the mucosa above and below the diaphragm, although some of the gastric rugae were abnormally red. A review of fifty-nine cases of esophageal hiatus hernia at the Cleveland Clinic revealed two with hypochromic anemia. Since no examinations of the stool were made in one case, one cannot be certain that the anemia in this case was secondary to bleeding from the gastro-intestinal tract. The other case is the subject of this report.

Report of Case

A white married woman, sixty years of age, was admitted to the hospital on April 30, 1939, because of dyspnea on the least activity, palpitation, weakness and fatigability, and attacks of pain in the chest. Twelve years earlier, she had fallen down a basement stairway and had been unconscious for a period somewhat less than an hour. There had been no fracture. Dyspnea on exertion had been noticed for the first time after this accident and had become gradually but progressively worse. At the time of admission to the hospital, even the act of getting into or out of bed caused severe shortness. . .