Section of Pulmonary and Critical Care Medicine, University of Chicago, 5841 S. Maryland Ave, MC 6076, Chicago, IL 60637, USA.
Eur Respir J. 2012 Feb;39(2):344-51. doi: 10.1183/09031936.00099910. Epub 2011 Jul 7.
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.
食管裂孔疝（HH）与胃食管反流（GOR）和/或 GOR 疾病相关，并且可能导致特发性肺纤维化（IPF）。我们假设通过计算机断层扫描评估的 HH 在 IPF 中比在哮喘或慢性阻塞性肺疾病（COPD）中更常见，并且与通过 pH 探针测试测量的异常 GOR 相关。在三个队列（IPF [n=100]、COPD [n=60]和哮喘 [n=24]）中比较 HH 的发生率，并评估观察者间的一致性。在 IPF 中，症状和抗反流药物与一氧化碳弥散量（D（L，CO））和综合生理指数（CPI）相关。在 IPF 患者中（n=14），HH 与 pH 探针测试相关。HH 在 IPF 中（39%）高于 COPD（13.3%，p=0.00009）或哮喘（16.67%，p=0.0139）。在 IPF 和哮喘中，HH 的观察者间κ一致性较强（κ=0.78 和 κ=0.86），在 COPD 中为中度（κ=0.42）。在 IPF 中，HH 与肺功能无关，除了那些接受抗反流治疗的患者，他们的 D（L，CO）（p<0.03）和 CPI（p<0.04）更好。HH 与通过 DeMeester 评分测量的 GOR 相关（p<0.04）。HH 在 IPF 中比 COPD 或哮喘更常见。在 IPF 队列中，HH 与更高的 DeMeester 评分相关，证实存在异常酸 GOR。单独存在 HH 与肺功能下降无关。
