Looking for the cause of iron deficiency anemia: a clinical case in the practice of a gastroenterologist

The paper presents a clinical case of the development of asymptomatic gastrointestinal bleeding (GIB) and iron deficiency anemia (IDA), caused by Cameron’s ulcer (CU; erosive lesion of the gastric mucosa localized in the hernia sac of the esophageal aperture diaphragmatic hernia). A brief review of literature data and American Gastroenterological Association (AGA) practice guidelines has been presented, confirming that CU is a typical gastroenterological cause of IDA development, manifested with latent or obvious GIВ. Simultaneous administration of non‑steroidal anti‑inflammatory drugs can provoke life‑threatening GIВ in CU patients. Large‑sized hiatal hernia, concomitant helminthiasis, H. pylori infection are recognized as aggravating factors for the development of CU and IDA. The gold standard for the CU diagnosis is upper endoscopy, although due to several reasons, this ulcerative defect may not be immediately detected, which requires radiological examination of the stomach. The first line of therapy of CU is considered to be the prescription of acid‑suppressive drugs, the optimal method of surgical treatment is laparoscopic fundoplication. The article describes the approach to the administration of eradication therapy according to the provisions of Maastricht consensus VI; the necessity of personalization of anti‑helicobacter therapy in a particular patient and the use of a three‑component regimen with clarithromycin is explained. The advantages of using bismuth‑containing drugs in eradication schemes are considered. The clinical efficacy of Ukrainian preparations (proton pump inhibitor Ezonexа®, bismuth‑containing drug Vis‑Nol®, prokinetic Itopride‑Pharmak) in CU healing has been described.