Elevated frequency and severity of asthma in patients with hiatal hernia: A retrospective study

Hiatal Hernia (HH) and gastroesophageal reflux disease (GERD) have been found to be associated with respiratory conditions, such as pulmonary fibrosis. However, their association with asthma remains ambiguous. Thus, the present cross-sectional, retrospective, monocentric study aimed to investigate the prevalence of asthma among patients with HH, evaluate its severity in these patients, and screen for associated respiratory symptoms. Additionally, the present study explored the association between the prevalence of asthma and various parameters, including sex, GERD medications and symptoms. For this purpose, a retrospective study, conducted at one central university medical center from January, 2020 to May, 2023, included patients with HH identified on a computed tomography scan. Patients were contacted and evaluated using structured questionnaires. Asthma-free patients underwent assessment for respiratory symptoms indicative of asthma using a validated questionnaire from the European Community Respiratory Health Survey. In patients with asthma, disease severity was assessed using the Global Initiative for Asthma symptom control criteria. The results revealed that out of 17,374 scans, 1,308 (7.53%) were positive for HH. Among the 453 cases eligible for analysis in the present study, 67 (14.79%) were diagnosed with asthma, of which 28 (41.79%) were diagnosed with uncontrolled asthma. Among the asthma-free patients, 136 (35.23%) reported at least one unspecified respiratory symptom. In the patients with HH, sex and GERD exhibited showed no association with asthma (P=0.07 and P=0.11, respectively). However, patients taking GERD medications exhibited a higher prevalence of asthma (P=0.03). On the whole, the present study demonstrates that the prevalence of asthma in patients with HH appears to be elevated. Hence, an ambivalence arises as regards the presence of a HH potentially associated with poorly controlled asthma and GERD medication potentially exacerbating asthma.