Hiatal hernias are correlated with increased severity of non-cystic fibrosis bronchiectasis

Background and objective Hiatal hernias (HH) are associated with gastro-oesophageal reflux and may contribute to lung disease severity. We aimed to evaluate the prevalence of HH among stable non-cystic fibrosis bronchiectasis (NCFB) patients and determine associations with disease severity. Methods A retrospective cross-sectional cohort study of 100 consecutive NCFB patients in our institution was performed. Data were collected on baseline variables, microbiology, lung function and radiology, according to the modified Bhalla score. Disease severity was assessed using the Bronchiectasis Severity Index (BSI) and FACED severity scores. Results Following expert radiological review, 81 patients were deemed suitable for study inclusion (mean age (SD) 62.6 (12.4), females 55 (67.9%), body mass index (BMI) 26.9 (5.7)); 29 (35.8%) were HH positive (HH+). HH+ patients had a trend towards higher BMI (P-=-0.07), and a significantly higher proportion had reflux symptoms (HH+ 62.1% vs HH- 28.8%, P-<-0.01). The presence of HH+ was associated with cystic bronchiectasis (HH+ 30.1%, HH- 11.5%; P-=-0.03), increased number of lobes involved (HH+ 2.62 (1.54), HH- 2.17 (1.42); P-=-0.03), increased extent of bronchiectasis, (HH+ 6.2 (4.7), HH- 4.5 (3.1); P-=-0.04), decreased parenchymal attenuation (HH+ 1.0 (1.8), HH- 0.2 (0.5); P-=-0.03) and reduced per-cent predicted forced expiratory volume in 1-s (HH+ 75.4% (24.5), HH- 90.4% (25.5); P-=-0.02). There was no lobar predilection. HH+ was associated with increased disease severity scores: BSI (HH+ 4.93 (1.65), HH- 3.25 (2.13); P-<-0.001) and FACED (HH+ 2.21 (1.52), HH- 1.35 (1.43); P-<-0.01). Conclusions HH+ was associated with worse disease severity in NCFB patients, characterized by decreased lung function, increased extent and severity of radiological disease, and increased composite disease severity scores. This is the first study to evaluate the role of hiatal hernias in bronchiectasis. The presence of a hiatal hernia was associated with worse disease severity, characterized by decreased lung function, increased extent and severity of radiological disease, and increased composite disease severity scores.