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

BackgroundHiatus 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 amongMUC5B(rs35705950) risk allele carriers.MethodsIn 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.ResultsHH 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 inMUC5Brisk allele carriers (p-value for interaction=0.02). HH was associated with ILAs among those ConclusionsHH was associated with more HAAs over time, particularly amongMUC5Brisk allele carriers, and ILAs in younger adults, and may be a risk factor in the early stages of interstitial lung disease.