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Background: Paraesophageal hernias may produce a variety of clinical sequelae. One of these is anemia, which may or may not be associated with esophageal or gastric ulcers. The purpose of this study was to assess the incidence of anemia in patients with paraesophageal hernias and frequency of resolution of anemia with hernia repair. Methods: Patients undergoing all types of laparoscopic or open paraesophageal hernia repairs from 7/96 through 9/10 were eligible for the study. Data gathered included age, gender, type of paraesophageal hernia, presence of anemia (defined as hemoglobin level <13.5gm/dl or symptomatic drop in hemoglobin), presence of symptomatic anemia or specific surgical referral for anemia from a paraesophageal hernia, presence of esophageal or gastric ulcers or erosions by endoscopy, type of repair, and resolution of anemia.Results: 187 patients underwent paraesophageal hernia repair, of these 66 (35%) were anemic. Of these anemic patients, 37 (56%) were symptomatic from their anemia or specifically referred for anemia, and 20 (30%) had esophageal or gastric ulceration/erosions. All patients underwent paraesophageal hernia repair, with 56 having documented follow-up. Overall, of these, 33 (59%) had resolution of their anemia. 68% of symptomatic patients had resolution of their anemia, compared to 48% of asymptomatic patients (p=0.1). Of patients with esophagogastric ulceration/erosion, 85% were symptomatic and 94% had resolution of anemia, compared to 53% of patients without ulceration/erosion (p=0.003).Conclusions: Anemia is a common finding in patients with paraesophageal hernia. Most of these patients were symptomatic because of their anemia. Those patients with esophageal or gastric ulceration or erosion were very likely to have symptomatic anemia, and, interestingly, these patients were more likely to have their anemia resolve with paraesophageal hernia repair. Patients with asymptomatic anemia or no ulceration/erosion were less likely to have resolution of their anemia with paraesophageal hernia repair.