Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
BMJ Open Gastroenterol. 2021 Mar;8(1). doi: 10.1136/bmjgast-2020-000565.
To determine the prevalence, risk factors and natural history of hiatal hernia (HH) on CT in the general population.
The Multi-Ethnic Study of Atherosclerosis (MESA) acquired full-lung CT on 3200 subjects, aged 53-94 years. Three blinded observers independently determined presence/absence and type (I-IV) of HH. Associations between HH and participant characteristics were assessed via unadjusted and multivariable-adjusted relative risk regression. HH natural history was assessed compared with prior MESA CT.
Excellent interobserver agreement was found for presence (κ=0.86) and type of HH (κ=0.97). Among 316 HH identified (prevalence=9.9%), 223 (71%) were type I and 93 (29%) were type III. HH prevalence increased with age, from 2.4% in 6th decade to 16.6% in 9th decade (unadjusted prevalence ratio (PR)=1.1 (95% CI 1.04 to 1.1)). HH prevalence was greater in women (12.7%) than men (7.0%) (unadjusted PR=1.8 (95% CI 1.5 to 2.3)) and associated with proton pump inhibitor use (p<0.001). In 75 participants with HH with 10-year follow-up, median HH area increased from 9.9 cm to 17.9 cm (p=0.02) with a higher mean body mass index (BMI) in subjects with increasing HH size compared with HH decreasing in size: mean BMI=30.2±6.2 vs 26.8±7.2 (p=0.02).
HH on non-contrast CT is prevalent in the general population, increasing with age, female gender and BMI. Its association with proton pump inhibitor use confirms a role in gastro-oesophageal reflux disease and HH progression is associated with increased BMI.
NCT00005487.
在普通人群中，通过 CT 确定食管裂孔疝（HH）的患病率、危险因素和自然病史。
多民族动脉粥样硬化研究（MESA）对 3200 名年龄在 53-94 岁的受试者进行了全肺 CT 检查。三名盲法观察者独立确定 HH 的存在/缺失和类型（I-IV）。通过未调整和多变量调整的相对风险回归评估 HH 与参与者特征之间的关联。与之前的 MESA CT 相比，评估了 HH 的自然病史。
观察者之间对 HH 的存在（κ=0.86）和类型（κ=0.97）具有极好的一致性。在 316 例确定的 HH 中（患病率为 9.9%），223 例（71%）为 I 型，93 例（29%）为 III 型。HH 的患病率随年龄增长而增加，从 6 个十年的 2.4%增加到 9 个十年的 16.6%（未调整的患病率比（PR）=1.1（95%CI 1.04 至 1.1））。女性（12.7%）HH 的患病率高于男性（7.0%）（未调整的 PR=1.8（95%CI 1.5 至 2.3）），与质子泵抑制剂的使用相关（p<0.001）。在 75 名有 10 年随访的 HH 患者中，HH 面积中位数从 9.9cm 增加到 17.9cm（p=0.02），与 HH 面积减小的患者相比，HH 面积增大的患者平均 BMI 较高：平均 BMI=30.2±6.2 与 26.8±7.2（p=0.02）。
非对比 CT 上的 HH 在普通人群中很常见，随着年龄、女性性别和 BMI 的增加而增加。它与质子泵抑制剂的使用相关，证实了其在胃食管反流病中的作用，HH 的进展与 BMI 的增加有关。
NCT00005487。
