Associations of Hiatus Hernia with CT-Based Interstitial Lung Changes: the MESA Lung Study.

Overview

abstract

Hiatus hernia (HH) is prevalent in adults with pulmonary fibrosis. We hypothesized that HH would be associated with markers of lung inflammation and fibrosis among community-dwelling adults and stronger among MUC5B (rs35705950) risk allele carriers.In the Multi-Ethnic Study of Atherosclerosis, HH was assessed from cardiac and full-lung computed tomography (CT) scans performed at Exam 1 (2000-2002, n=3342) and Exam 5 (2010-2012, n=3091), respectively. Percentage of high attenuation areas (HAAs, % of voxels with attenuation between -600 and -250 Hounsfield units) was measured from cardiac and lung scans. Interstitial lung abnormalities (ILA) were examined from Exam 5 scans (n=2380). Regression models were used to examine the associations of HH with HAAs, ILA, serum matrix metalloproteinase-7, and adjusted for age, sex, race/ethnicity, educational attainment, smoking, height, weight, and scanner parameters for HAAs analysis.HH detected from Exam 5 scans was associated with a mean % difference in HAAs of 2.23% (95% CI 0.57-3.93) and an increase of 0.48% increase/year (95% CI 0.07-0.89), particularly in MUC5B risk allele carriers (p-value for interaction=0.02). HH was associated with ILA among those younger than 80 years of age (odds ratio for ILA 1.78, 95% CI 1.14-2.80) and higher serum matrix metalloproteinase-7 level among smokers (p-value for interaction=0.04).Hiatus hernia was associated with more HAAs over time, particularly among MUC5B risk allele carriers, and ILA in younger adults and may be a risk factor in the early stages of interstitial lung disease.