title: Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis.
abstract: Hiatal hernia (HH) is associated with gastro-oesophageal reflux (GOR) and/or GOR disease and may contribute to idiopathic pulmonary fibrosis (IPF). We hypothesised that HH evaluated by computed tomography is more common in IPF than in asthma or chronic obstructive pulmonary disease (COPD), and correlates with abnormal GOR measured by pH probe testing. Rates of HH were compared in three cohorts, IPF (n=100), COPD (n=60) and asthma (n=24), and evaluated for inter-observer agreement. In IPF, symptoms and anti-reflux medications were correlated with diffusing capacity of the lung for carbon monoxide (D(L,CO)) and composite physiologic index (CPI). HH was correlated with pH probe testing in IPF patients (n=14). HH was higher in IPF (39%) than either COPD (13.3%, p=0.00009) or asthma (16.67%, p=0.0139). The HH inter-observer κ agreement was substantial in IPF (κ=0.78) and asthma (κ=0.86), and moderate in COPD (κ=0.42). In IPF, HH did not correlate with lung function, except in those on anti-reflux therapy, who had a better D(L,CO) (p<0.03) and CPI (p<0.04). HH correlated with GOR as measured by DeMeester scores (p<0.04). HH is more common in IPF than COPD or asthma. In an IPF cohort, HH correlated with higher DeMeester scores, confirming abnormal acid GOR. Presence of HH alone was not associated with decreased lung function.
authors: Section of Pulmonary and Critical Care Medicine, University of Chicago, 5841 S. Maryland Ave, MC 6076, Chicago, IL 60637, USA. inoth@medicine.bsd.uchicago.edu
authors: I
authors: I
authors: Noth
authors: S M
authors: SM
authors: Zangan
authors: R V
authors: RV
authors: Soares
authors: A
authors: A
authors: Forsythe
authors: C
authors: C
authors: Demchuk
authors: S M
authors: SM
authors: Takahashi
authors: S B
authors: SB
authors: Patel
authors: M E
authors: ME
authors: Strek
authors: J A
authors: JA
authors: Krishnan
authors: M G
authors: MG
authors: Patti
authors: H
authors: H
authors: Macmahon
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000000981:diagnostic imaging / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*