ABSTRACT
Hiatal hernia (HH) is associated with gastro-oesophageal reflux (GOR) and/or GOR disease and may contribute to idiopathic pulmonary fibrosis (IPF). We hypothesised that HH evaluated by computed tomography is more common in IPF than in asthma or chronic obstructive pulmonary disease (COPD), and correlates with abnormal GOR measured by pH probe testing. Rates of HH were compared in three cohorts, IPF (n=100), COPD (n=60) and asthma (n=24), and evaluated for inter-observer agreement. In IPF, symptoms and anti-reflux medications were correlated with diffusing capacity of the lung for carbon monoxide (D(L,CO)) and composite physiologic index (CPI). HH was correlated with pH probe testing in IPF patients (n=14). HH was higher in IPF (39%) than either COPD (13.3%, p=0.00009) or asthma (16.67%, p=0.0139). The HH inter-observer κ agreement was substantial in IPF (κ=0.78) and asthma (κ=0.86), and moderate in COPD (κ=0.42). In IPF, HH did not correlate with lung function, except in those on anti-reflux therapy, who had a better D(L,CO) (p<0.03) and CPI (p<0.04). HH correlated with GOR as measured by DeMeester scores (p<0.04). HH is more common in IPF than COPD or asthma. In an IPF cohort, HH correlated with higher DeMeester scores, confirming abnormal acid GOR. Presence of HH alone was not associated with decreased lung function.
Subject(s)
Hernia, Hiatal/diagnostic imaging , Hernia, Hiatal/epidemiology , Idiopathic Pulmonary Fibrosis/diagnostic imaging , Idiopathic Pulmonary Fibrosis/epidemiology , Tomography, X-Ray Computed/statistics & numerical data , Adult , Aged , Asthma/diagnostic imaging , Asthma/epidemiology , Cohort Studies , Female , Gastroesophageal Reflux/diagnostic imaging , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/therapy , Humans , Hydrogen-Ion Concentration , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/epidemiology , Male , Manometry , Middle Aged , Observer Variation , Prevalence , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Pulmonary Disease, Chronic Obstructive/epidemiology , Retrospective Studies , Severity of Illness IndexABSTRACT
Though rare, dialysis associated steal syndrome (DASS) can cause debilitating symptoms. Surgical revision of the dialysis access is typically required. We describe a percutaneous technique to alleviate steal syndrome utilizing a constrained stent within an arteriovenous graft. A brief review of the incidence, pathophysiology, and standard treatment of DASS is also provided.
