Extract
The prevalence of hiatus hernia in patients with idiopathic pulmonary fibrosis (IPF) is ∼40% [1–3], greater than the prevalence of hiatus hernia in other chronic lung diseases. While the role of gastro-oesophageal reflux disease (GORD) and its treatment remain an area of controversy in IPF [4, 5], hiatus hernia is associated with reduced survival [2, 3] and more rapid lung function decline [3]. The cause for the increased prevalence of hiatus hernia in IPF remains unknown. It is possible that the increased rate of GORD associated with hiatus hernia leads to frequent chronic micro-aspiration events [1], which could contribute to the development of pulmonary fibrosis. Alternatively, it is plausible that as IPF progresses, the biomechanics of the fibrotic lung result in progressively more negative intrathoracic pressure causing cranial migration of the oesophagogastric junction (GOJ) and stomach into the thorax. The association between hiatus hernia and early stages of pulmonary fibrosis has not been assessed previously.
Abstract
Hiatus hernia is not associated with ILA or its progression, but is twice as prevalent in those with UIP than other subtypes and those without ILA. Moderate to large hiatus hernia is strongly linked to an increased risk of mortality across 4885 participants https://bit.ly/3gy7yq7
Footnotes
Conflict of interest: P.M. George reports personal fees from Roche Pharmaceuticals and Teva, grants and personal fees from Boehringer Ingelheim, outside the submitted work.
Conflict of interest: T. Hida has nothing to disclose.
Conflict of interest: R.K. Putman reports grants from NIH, during the conduct of the study.
Conflict of interest: T. Hino has nothing to disclose.
Conflict of interest: S.R. Desai has nothing to disclose.
Conflict of interest: A. Devaraj reports personal fees from Boehringer Ingelheim, Galapagos, Galecto Biotech and GSK, outside the submitted work.
Conflict of interest: S. Kumar has nothing to disclose.
Conflict of interest: J.A. Mackintosh reports personal fees for lectures from Roche, outside the submitted work.
Conflict of interest: V. Gudnason has nothing to disclose.
Conflict of interest: H. Hatabu reports grants from Canon Medical System Inc. and Konica-Minolta Inc., personal fees for consultancy from Mitsubishi Chemical Inc., and has been member of an advisory board for Canon Medical System Inc., outside the submitted work.
Conflict of interest: G. Gudmundsson has nothing to disclose.
Conflict of interest: G.M. Hunninghake reports personal fees from Boehringer Ingelheim, Mitsubishi Chemical and Gerson Lehrman Group, outside the submitted work.
- Received February 26, 2020.
- Accepted May 27, 2020.
- Copyright ©ERS 2020