RESUMO
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.
Assuntos
Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/epidemiologia , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Fibrose Pulmonar Idiopática/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Idoso , Asma/diagnóstico por imagem , Asma/epidemiologia , Estudos de Coortes , Feminino , Refluxo Gastroesofágico/diagnóstico por imagem , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/terapia , Humanos , Concentração de Íons de Hidrogênio , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Manometria , Pessoa de Meia-Idade , Variações Dependentes do Observador , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
There were over 220,000 people diagnosed with lung cancer and over 160,000 people dying of lung cancer during 2010 alone in the United States. In order to arrive at better control, prevention, diagnosis, and therapeutics for lung cancer, we must be able to personalize the approach towards the disease. Mind-mapping has existed for centuries for physicians to properly think about various "flows" of personalized medicine. We include here the epidemiology, diagnosis, histology, and treatment of lung cancer-in particular, non-small cell lung cancer. As we have new molecular signatures for lung cancer, this is further detailed. This review is not meant to be a comprehensive review, but rather its purpose is to highlight important aspects of lung cancer diagnosis, management, and personalized treatment options.