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. 2023 Jan 27;61(1):2103173.
doi: 10.1183/13993003.03173-2021. Print 2023 Jan.

Associations of hiatus hernia with CT-based interstitial lung changes: the MESA Lung Study

John S Kim  1   2 , Jinhye Kim  3   4 , Xiaorui Yin  3 , Grant T Hiura  2 , Michaela R Anderson  5 , Eric A Hoffman  6 , Ganesh Raghu  7 , Imre Noth  8 , Ani Manichaikul  9 , Stephen S Rich  9 , Benjamin M Smith  2   10 , Anna J Podolanczuk  11 , Christine Kim Garcia  2 , R Graham Barr  2   12 , Martin R Prince  3   13 , Elizabeth C Oelsner  2   12
Affiliations

Associations of hiatus hernia with CT-based interstitial lung changes: the MESA Lung Study

John S Kim et al. Eur Respir J. .

Abstract

Background: Hiatus hernia (HH) is prevalent in adults with pulmonary fibrosis. We hypothesised that HH would be associated with markers of lung inflammation and fibrosis among community-dwelling adults and stronger among MUC5B (rs35705950) risk allele carriers.

Methods: 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; percentage of voxels with attenuation between -600 and -250 HU) was measured from cardiac and lung scans. Interstitial lung abnormalities (ILAs) were examined from Exam 5 scans (n=2380). Regression models were used to examine the associations of HH with HAAs, ILAs and serum matrix metalloproteinase-7 (MMP-7), and adjusted for age, sex, race/ethnicity, educational attainment, smoking, height, weight and scanner parameters for HAA analysis.

Results: HH detected from Exam 5 scans was associated with a mean percentage difference in HAAs of 2.23% (95% CI 0.57-3.93%) and an increase of 0.48% (95% CI 0.07-0.89%) per year, particularly in MUC5B risk allele carriers (p-value for interaction=0.02). HH was associated with ILAs among those <80 years of age (OR for ILAs 1.78, 95% CI 1.14-2.80) and higher serum MMP-7 level among smokers (p-value for smoking interaction=0.04).

Conclusions: HH was associated with more HAAs over time, particularly among MUC5B risk allele carriers, and ILAs in younger adults, and may be a risk factor in the early stages of interstitial lung disease.

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Conflict of interest statement

Conflicts of interest: J.S. Kim reports a K23 grant from the National Heart, Lung, and Blood Institute related to the current study; is the recipient of a Pulmonary Fibrosis Foundation Scholar's Award; and has participated on a data safety monitoring board for a UVA Convalescent Plasma Trial. J. Kim has nothing to disclose. X. Yin has nothing to disclose. G.T. Hiura has nothing to disclose. M.R. Anderson reports a grant from the National Heart, Lung, and Blood Institute related to the current study. E.A. Hoffman reports National Institutes of Health grant funding to the University of Iowa, related to the current study; and is a founder and shareholder of VIDA Diagnostics, a company commercialising lung image analysis software developed, in part, at the University of Iowa. G. Raghu has nothing to disclose. I. Noth reports having received grants from the National Heart, Lung, and Blood Institute; and consulting fees from Boehringer Ingelheim, Genentech and Confo, in the 36 months prior to manuscript submission. A. Manichaikul reports a grant from the National Heart, Lung, and Blood Institute related to the current study. S.S. Rich has nothing to disclose. B.M. Smith reports National Institutes of Health grant R01-HL130506, paid to their institution related to the current study; and further grants to their institution from the National Institutes of Health, Canadian Institutes of Health Research and Fonds de Recherche du Québec, in the 36 months prior to manuscript submission. A.J. Podolanczuk reports a grant from the National Heart, Lung, and Blood Institute related to the current study; further grant funding from the American Lung Association; consulting fees from Regeneron, Boehringer Ingelheim, Imvaria and the National Association for Continuing Education; and participation on an ILD-related advisory board for Boehringer Ingelheim, all in the 36 months prior to manuscript submission. C.K. Garcia reports a grant from the National Heart, Lung, and Blood Institute related to the current study; as well as investigator-initiated research support from the Department of Defense and Boehringer Ingelheim; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Three Lakes Foundation and Stanford University, all in the 36 months prior to manuscript submission; as well as stock or stock options in Pliant Therapeutics; and a collaboration with AstraZeneca regarding genomic sequencing in 2020. R.G. Barr reports having received grants from the National Heart, Lung, and Blood Institute and the COPD Foundation. M.R. Prince has nothing to disclose. E.C. Oelsner has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart of participants with Multi-Ethnic Study of Atherosclerosis (MESA) Exam 5 hiatus hernia (HH) and a) high attenuation area (HAA) and b) interstitial lung abnormality (ILA) assessments from Exam 5 full-lung scans. c) Participants with HH assessments from Exam 1 scans and repeat assessment from Exam 5 scans.
FIGURE 2
FIGURE 2
Forest plots showing associations of Multi-Ethnic Study of Atherosclerosis Exam 5 hiatus hernia (HH), HH types, distance between the gastric fold and diaphragm, and serial assessments of HH with a) Exam 5 high attenuation areas (HAAs) from full-lung scans and b) longitudinal changes in HAAs. Results are reported for every 20% increase in distance for gastric fold and diaphragm distance analysis. p-values for MUC5B interaction were a) 0.18 and b) 0.02. Square data points represent effect estimates and horizontal lines represent 95% confidence intervals.
FIGURE 3
FIGURE 3
Kaplan–Meier survival curves of Multi-Ethnic Study of Atherosclerosis Exam 1 hiatus hernia (HH) status and MUC5B (rs35705950) risk allele (T) carrier status.
See this image and copyright information in PMC

Comment in

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