title: Hiatal hernias are correlated with increased severity of non-cystic fibrosis bronchiectasis.
abstract: OBJECTIVE
  Hiatal hernias (HH) are associated with gastro-oesophageal reflux and may contribute to lung disease severity. We aimed to evaluate the prevalence of HH among stable non-cystic fibrosis bronchiectasis (NCFB) patients and determine associations with disease severity.
  
  
  METHODS
  A retrospective cross-sectional cohort study of 100 consecutive NCFB patients in our institution was performed. Data were collected on baseline variables, microbiology, lung function and radiology, according to the modified Bhalla score. Disease severity was assessed using the Bronchiectasis Severity Index (BSI) and FACED severity scores.
  
  
  RESULTS
  Following expert radiological review, 81 patients were deemed suitable for study inclusion (mean age (SD) 62.6 (12.4), females 55 (67.9%), body mass index (BMI) 26.9 (5.7)); 29 (35.8%) were HH positive (HH+). HH+ patients had a trend towards higher BMI (P = 0.07), and a significantly higher proportion had reflux symptoms (HH+ 62.1% vs HH- 28.8%, P < 0.01). The presence of HH+ was associated with cystic bronchiectasis (HH+ 30.1%, HH- 11.5%; P = 0.03), increased number of lobes involved (HH+ 2.62 (1.54), HH- 2.17 (1.42); P = 0.03), increased extent of bronchiectasis, (HH+ 6.2 (4.7), HH- 4.5 (3.1); P = 0.04), decreased parenchymal attenuation (HH+ 1.0 (1.8), HH- 0.2 (0.5); P = 0.03) and reduced per cent predicted forced expiratory volume in 1 s (HH+ 75.4% (24.5), HH- 90.4% (25.5); P = 0.02). There was no lobar predilection. HH+ was associated with increased disease severity scores: BSI (HH+ 4.93 (1.65), HH- 3.25 (2.13); P < 0.001) and FACED (HH+ 2.21 (1.52), HH- 1.35 (1.43); P < 0.01).
  
  
  CONCLUSIONS
  HH+ was associated with worse disease severity in NCFB patients, characterized by decreased lung function, increased extent and severity of radiological disease, and increased composite disease severity scores.
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.|Institute of Cell and Molecular Biosciences, Framlington Place, Newcastle Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors: Melissa Jane
authors: MJ
authors: McDonnell
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: Mohammad
authors: M
authors: Ahmed
authors: Department of Radiology, Galway University Hospitals, Galway, Ireland.
authors: Jeeban
authors: J
authors: Das
authors: Institute of Cell and Molecular Biosciences, Framlington Place, Newcastle Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors: Chris
authors: C
authors: Ward
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: Matshediso
authors: M
authors: Mokoka
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: David P
authors: DP
authors: Breen
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: Anthony
authors: A
authors: O'Regan
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: John J
authors: JJ
authors: Gilmartin
authors: Department of Radiology, Galway University Hospitals, Galway, Ireland.
authors: John
authors: J
authors: Bruzzi
authors: Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
authors: Robert M
authors: RM
authors: Rutherford
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001987:Bronchiectasis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: bronchiectasis; hiatal hernia; prevalence; scoring system; severity