The majority of patients with IPF have pathological gastroesophageal reflux,1314 though the clinical implications of reflux on the IPF disease course are not fully understood.5 The presence of hiatal hernia is implicated as a cause of gastroesophageal reflux, and it has been hypothesized that the incidence of hiatal hernia may be higher in patients with IPF than those with other lung diseases including asthma or COPD.15
Hiatal hernia may be distinguished on HRCT by evaluating the location of the esophagus in relation to the diaphragm.15 For a proper diagnosis of hiatal hernia, the lower esophageal ring must be ≥1-2 cm above the level of the diaphragmatic hiatus.1516