Hiatal hernia on thoracic computed tomography in pulmonary fibrosis

Abstract

Gastro-oesophageal reflux has long been suspected of implication in the genesis and progression of idiopathic pulmonary fibrosis (IPF). We hypothesised that hiatal hernia may be more frequent in IPF than in other interstitial lung disease (ILD), and that hiatal hernia may be associated with more severe clinical characteristics in IPF.We retrospectively compared the prevalence of hiatal hernia on computed tomographic (CT) scans in 79 patients with IPF and 103 patients with other ILD (17 scleroderma, 54 other connective tissue diseases and 32 chronic hypersensitivity pneumonitis). In the IPF group, we compared the clinical, biological, functional, CT scan characteristics and mortality of patients with hiatal hernia (n=42) and without hiatal hernia (n=37).The prevalence of hiatal hernia on CT scan at IPF diagnosis was 53%, similar to ILD associated with scleroderma, but significantly higher than in the two other ILD groups. The size of the hiatal hernia was not linked to either fibrosis CT scan scores, or reduction in lung function in any group. Mortality from respiratory causes was significantly higher among IPF patients with hiatal hernia than among those without hiatal hernia (p=0.009).Hiatal hernia might have a specific role in IPF genesis, possibly due to pathological gastro-oesophageal reflux.

Oesophageal diameter is associated with severity but not progression of systemic sclerosis‐associated interstitial lung disease

“…We found that hiatal hernia was both common and associated with baseline fibrosis score in SSc‐ILD, although there was no independent association of hiatal hernia with disease progression or mortality. The 21% hiatal hernia prevalence reported in our study was less than the 59% observed in a recent retrospective study of scleroderma patients and the 39–53% prevalence reported in IPF, and is more comparable to the prevalence previously observed in COPD (13%) and asthma (17%) . The reasons for these differences with other ILD cohorts are unclear.…”

The Role of the Transdiaphragmatic Pressure Gradient in the Pathophysiology of Gastroesophageal Reflux Disease

“…The association of GERD and pulmonary disease is a frequent one and certainly a causality association not a spurious relation. Several recent studies showed an increased prevalence of GERD in patients with asthma, pulmonary fibrosis, chronic cough and chronic obstructive pulmonary disease (COPD) (12,17,(49)(50)(51)(52) . GERD may damage the lung due to aspiration of gastric contents but pulmonary diseases may cause GERD due to changes in the TPG.…”

Personalized medicine in interstitial lung diseases

“…Asymptomatic GER and nonacid GER are also common in IPF [19,20 & ], complicating the manner in which GER is diagnosed and prevalence determined. In addition to GER, a large minority of patients with IPF also suffer from a hiatal hernia, which may exacerbate GER and further contribute to microaspiration [21,22].…”