Iron deficiency anemia (IDA) remains a global health concern, frequently resulting from chronic occult gastrointestinal blood loss. Lower esophageal sphincter (LES) incompetence, commonly manifested as hiatal hernia, can contribute to mucosal injury (e.g., Cameron lesions) and gastroesophageal reflux, leading to iron depletion. This cross-sectional study investigated radiological signs of LES incompetence using barium-contrast upper gastrointestinal series in 52 adult patients with confirmed IDA. Hiatal hernia, indicating LES incompetence, was identified in 28 patients (53.8%), with sliding (Type I) hernia being the most prevalent (46.2%). Gastroesophageal reflux was observed in 60.7% of hernia-positive cases, and linear mucosal irregularities suggestive of Cameron erosions appeared in 19.2% of the cohort. A significant negative correlation was found between the presence of hiatal hernia and both hemoglobin levels (r = −0.62, p < 0.01) and serum ferritin (r = −0.59, p < 0.01). These results underscore the value of conventional barium esophagography as a non-invasive, cost-effective tool for detecting LES incompetence in patients with unexplained or refractory IDA, particularly in settings where advanced endoscopy is limited. Early radiological identification may guide targeted therapy, including hernia repair, and improve hematologic outcomes.

Iron deficiency anemia, lower esophageal sphincter incompetence, hiatal hernia, Cameron lesions, barium swallow, gastroesophageal reflux, radiology

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