Thoracic Deformity and Hiatal Hernia (Intrathoracic Stomach) in the Elderly

Abstract

The incidence of hiatal hernia (HH) increases with age. Vertebral fracture, kyphosis, and pulmonary emphysema are suspected as possible causes. We aimed to analyze the relationship between thoracic deformities and HH in the elderly, using a deformity index. The study participants comprised 427 inpatients at a long-term-care hospital for the elderly in Japan. The Haller index (HI) was calculated on the transverse thoracic computerized tomography images according to the following formula: transverse diameter of the thorax/anterior-posterior diameter of the thorax. HH was diagnosed when an intrathoracic stomach was seen on the computed tomography images. The average HI calculated for all cases and for women--but not for men--decreased with increasing age. HH was diagnosed in 21 patients (4.9%). The incidence of HH in women was higher than in men (male vs. female = 2.0% vs. 7.4%). The mean value of HI in the HH patients (1.651 ± 0.251) was significantly lower than that in non-HH patients (2.345 ± 0.460). Enlargement of the anterior-posterior diameter of the thorax occurs in the elderly and is associated with the occurrence of HH.