X-Ray Diagnostics of Esophageal Hernia in Patients with Iron Deficiency Anemia

Abstract

Iron deficiency anemia (IDA) is a widespread hematologic condition often linked to nutritional deficits or chronic blood loss. However, gastrointestinal causes—particularly esophageal hernia—are frequently underdiagnosed contributors. This study investigates the role of X-ray diagnostics in identifying esophageal hernia among patients with IDA. A total of 52 patients with confirmed iron deficiency anemia underwent upper gastrointestinal barium-contrast radiography. The results revealed esophageal hernia in 53.8% of cases, predominantly sliding hernias. A significant correlation was observed between the presence of hernia and the severity of anemia. Additionally, mucosal erosions and reflux were frequently identified among those with moderate to severe IDA. These findings demonstrate that X-ray imaging is a valuable and accessible tool in detecting esophageal hernia, especially in cases of unexplained or treatment-resistant anemia. Incorporating radiological screening into diagnostic protocols may improve detection rates and guide appropriate gastroenterological management.

Introduction

Iron deficiency anemia (IDA) is a common global health issue, often caused by dietary deficiencies or chronic blood loss. However, esophageal (hiatal) hernias, particularly sliding hernias, are increasingly recognized as underdiagnosed contributors to IDA. These hernias can lead to occult gastrointestinal bleeding, reflux, and mucosal lesions (e.g., Cameron erosions), which may cause chronic iron loss, even in the absence of gastrointestinal symptoms.

Study Overview:

This cross-sectional study examined 52 adult patients with confirmed IDA at a regional medical center. Patients with known anemia causes or prior hernia diagnoses were excluded. All participants underwent upper GI barium-contrast X-ray imaging, and their clinical symptoms and hematological parameters were recorded.

Key Findings:

• Hiatal hernia was detected in 53.8% of patients via X-ray:

  • Sliding hernia (Type I): 46.2%

  • Paraesophageal hernia (Type II): 5.8%

  • Mixed type (Type III): 1.9%

• Gastroesophageal reflux was observed in 60.7% of hernia cases.

• Cameron-like erosions, linked to blood loss, were found in 19.2% of all patients—mainly those with moderate or severe anemia.

• There was a significant correlation between presence of hernia and lower hemoglobin (r = -0.62) and serum ferritin (r = -0.59).

• High interobserver agreement in radiographic diagnosis (Cohen’s κ = 0.87).

Discussion:

The study highlights the clinical importance of detecting esophageal hernia in patients with unexplained or refractory IDA. Even without overt symptoms, hernias may cause chronic iron loss, contributing to persistent anemia. X-ray imaging, especially barium-contrast studies, proved effective for identifying hernias and related complications in a cost-effective and accessible manner—particularly valuable in resource-limited settings where endoscopy or CT might not be available.

Clinical Implications:

• Incorporating routine upper GI imaging in IDA workups—especially when no other source of anemia is found—can improve diagnostic accuracy.

• The study encourages a multidisciplinary approach, involving hematologists, radiologists, and gastroenterologists.

• Findings support the role of structural GI abnormalities in IDA and call for increased clinical awareness.

Limitations:

• Cross-sectional design limits ability to establish causality.

• Lack of endoscopic confirmation in all patients.

• Relatively small and demographically limited sample size.

Conclusion

Conventional X-ray imaging is a reliable and practical tool for diagnosing esophageal hernia in patients with iron deficiency anemia. Its use should be encouraged, particularly in cases of unexplained or treatment-resistant anemia, to facilitate early intervention and improve patient outcomes.

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Copyright

Copyright © 2025 Vakhidov Feruz Faezovich, Ummatov Bakhtiyor Kakharovich, Madasheva Anajan Gazkhanovna. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.