Six patients presenting with initially obscure pulmonary fibrosis are described. Reasons are given for attributing the condition to chronic aspiration pneumonitis from gastro-oesophageal reflux in association with hiatus hernia, supported by lung histology in three cases. Study of a further series of 143 cases of hiatus hernia suggests a 4% incidence of this insidious complication in addition to any more acute bronchopulmonary episodes. This possibility should be remembered in the differential diagnosis of any patient with pulmonary fibrosis of doubtful origin, as the advanced condition bears a poor prognosis.
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