Associations of hiatus hernia with CT-based interstitial lung changes: the MESA Lung Study

A Comprehensive Review of Interstitial Lung Abnormalities

Interstitial lung abnormalities (ILAs) represent radiological entities that comprise changes compatible with an interstitial process, occurring in individuals not suspected to have interstitial lung disease (ILD). The prevalence of ILAs ranges from 2.5% to 16.7% in lung cancer screening and population-based cohorts. ILAs have consistently been associated with mortality. Risk factors include older age, smoking, and genetic polymorphisms such as MUC5B. Progression of ILAs occurs in 20%-76% of cases over 2-6 years of follow-up. The clinical approach to ILAs involves risk stratification based on radiological features, extent of involvement, and associated clinical and physiological findings. ILAs pose a significant challenge in distinguishing inconsequential radiological findings from early ILD. This review summarises the current understanding of ILAs, including prevalence, risk factors, progression, associated biomarkers, and clinical management strategies.

Development and validation of a universal esophageal patient-reported outcome measure: The Cleveland Clinic Esophageal Questionnaire (CEQ)

OBJECTIVE

Currently, there is no validated patient-reported outcome measure (PROM) applicable to all esophageal diseases. Our objective was to create a psychometrically robust, validated universal esophageal PROM that can also objectively assess patients' quality of life (QoL).

METHODS

The pilot PROM constructed based on expert opinions, literature review, and previous unpublished institutional research had 27 items covering 8 domains. It was completed by 30 patients in the outpatient clinic followed by a structured debriefing interview, which allowed for refining the PROM. The final PROM: Cleveland Clinic Esophageal Questionnaire (CEQ) included 34 items across 6 domains (Dysphagia, Eating, Pain, Reflux & Regurgitation, Dyspepsia, Dumping), each accompanied by a corresponding QoL component. Further psychometric assessment of the PROM was conducted by evaluating (1) acceptability, (2) construct validity, (3) reliability, and (4) responsiveness.

RESULTS

Five hundred forty-six unique patients (median 63.7 years [54.3-71.7], 53% male [287], 86% White) completed CEQ at >90% completion within 5 minutes. Construct validity was demonstrated by differentiating scores across esophageal cancer (n = 146), achalasia (n = 170), hiatal hernia (n = 160), and other diagnoses (n = 70). Internal reliability (Cronbach alpha 0.83-0.89), and test-retest reliability (intraclass correlation coefficients 0.63-0.85) were strong. Responsiveness was demonstrated through CEQ domains improving for 53 patients who underwent surgery for achalasia or hiatal hernia (Cohen d 0.86-2.59).

CONCLUSIONS

We have constructed a psychometrically robust, universal esophageal PROM that allows concise, consistent, objective quantification of symptoms and their effect on the patient. The CEQ is valuable in prognostication and tracking of longitudinal outcomes in both benign and malignant esophageal diseases.