Abstract
Hiatal hernia (HH) is associated with gastroesophageal reflux (GER) and/or GER disease (GERD) and may contribute to idiopathic pulmonary fibrosis (IPF). We hypothesized that HH evaluated by computed tomography (CT) is more common in IPF than asthma or COPD, and correlates with abnormal GER 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 (DL,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<0.0001) or asthma (16.67%, p<0.02). The HH inter-observer k agreement was substantial in IPF (k 0.78) and asthma (k 0.70), and moderate in COPD (k 0.42). In IPF, HH did not correlate with lung function excepting those on anti-reflux therapy; who had a better DL,CO (p<0.04) and CPI (p<0.04). HH correlated with GER 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 GERD. Presence alone of HH was not associated with decreased lung function.
- Computed tomography
- gastroesophageal reflux
- Hiatus hernia
- idiopathic pulmonary fibrosis
- interstitial lung disease
- ERS