title: Hospitalization with respiratory disease following hiatal hernia and reflux esophagitis in a prospective, population-based study.
abstract: OBJECTIVE
  Hiatal hernia and reflux esophagitis have been associated with respiratory manifestations, though the temporal sequence of this relationship is uncertain. This study examined prospectively the relationship of hiatal hernia and reflux esophagitis with respiratory outcomes in a representative sample of the United States population.
  
  
  METHODS
  6928 participants in the first National Health and Nutrition Examination Survey, a population-based sample initially examined in 1971-1975, who were hospitalized during follow-up through 1992-1993 composed the study population. The relationship between hiatal hernia and reflux esophagitis hospitalization and a subsequent hospitalization with respiratory outcomes was measured in persons free of respiratory disease at baseline and at first hospitalization.
  
  
  RESULTS
  Multivariable survival analysis showed higher rates of hospitalization with any respiratory diagnosis [rate ratio (RR) = 1.4, 95% confidence interval (CI) 1.2-1.7] in persons with preceding hiatal hernia or reflux esophagitis hospitalization. Individually, rate ratios of pharyngitis (RR = 5.6, CI 2.0-15.7), tonsillitis (RR = 8.0, CI 2.5-25.8), bronchitis (RR = 1.8, CI 1.2-2.7), pneumonia (RR = 1.3, CI 1.0-1.7), emphysema (RR = 2.9, CI 1.5-5.5), asthma (RR = 2.1, CI 1.1-4.2), bronchiectasis (RR = 6.2, CI 1.1-34.3), and empyema or abscess (RR = 7.4, CI 1.3-42.3) were all higher following hiatal hernia and reflux esophagitis. Rate ratios were similar when reflux esophagitis and hiatal hernia were examined separately.
  
  
  CONCLUSIONS
  A prior hiatal hernia or reflux esophagitis hospitalization increased risk of respiratory disease hospitalization.
authors.affiliation: Social and Scientific Systems, Inc., 7101 Wisconsin Ave., Bethesda, MD 20814-4805, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Ruhl
authors.forename: A
authors.initials: A
authors.lastname: Sonnenberg
authors.forename: J E
authors.initials: JE
authors.lastname: Everhart
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004942:Esophagitis, Peptic / Q000150:complications*; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology