{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T17:28:57Z","timestamp":1771954137442,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Thoracic kyphosis has been increasingly associated with altered intra-abdominal and diaphragmatic dynamics, potentially contributing to gastroesophageal reflux disease (GERD) and hiatal hernia (HH). While previous studies have shown a relationship between spinal deformities and GERD symptoms, these findings have been largely observational, with few morphometric analyses. No prior study has directly quantified the relationship between thoracic curvature and hiatal surface area (HSA) using standardized computed tomography (CT)-based methods. Furthermore, existing studies have typically focused on patients with visible hernias, limiting understanding of early, subclinical anatomical changes. This study addresses this gap by evaluating whether thoracic kyphosis is associated with measurable hiatal enlargement, even in the absence of overt HH. Methods: In this retrospective, single-center study, 100 adult patients (50 with thoracic kyphosis, defined as a Cobb angle of \u226550\u00b0 and 50 age- and sex-matched controls) underwent multidetector CT (MDCT). Hiatal surface area (HSA) was measured on a standardized oblique axial plane aligned with the diaphragmatic crura. Correlation and multivariable regression analyses were performed to assess relationships between Cobb angle and HSA. Results: The kyphosis group showed significantly larger HSA than controls (5.14 \u00b1 1.31 cm2 vs. 3.59 \u00b1 0.74 cm2; p &lt; 0.001). A moderate positive correlation was found between Cobb angle and HSA (r = 0.336, p = 0.017). Multivariable analysis identified the Cobb angle as an independent predictor of HSA (\u03b2 = 0.028; p = 0.017), while age and sex were not significant predictors. No overt herniation was present in any subject. Conclusions: This is the first CT-based morphometric study to demonstrate that thoracic kyphosis is associated with hiatal enlargement, even in the absence of overt herniation. These findings support the hypothesis that postural spinal deformities may predispose individuals to GERD by structurally remodeling the diaphragmatic hiatus.<\/jats:p>","DOI":"10.3390\/tomography11090098","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T14:43:18Z","timestamp":1756219398000},"page":"98","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Thoracic Kyphosis and Hiatal Enlargement: A CT-Based Study Interpreted in Light of GERD-Linked Morphological Markers"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1142-213X","authenticated-orcid":false,"given":"Mustafa","family":"Maz\u0131can","sequence":"first","affiliation":[{"name":"Department of Radiology, Division of Interventional Radiology, Ba\u015fkent University Dr. Turgut Noyan Application and Research Center, 01250 Adana, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismail","family":"Karluka","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Interventional Radiology, Ba\u015fkent University Dr. Turgut Noyan Application and Research Center, 01250 Adana, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0021-7835","authenticated-orcid":false,"given":"Davut","family":"Tuney","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Marmara University, 34722 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref_1","first-page":"455","article-title":"Kyphosis and review of the literature","volume":"24","author":"Yaman","year":"2014","journal-title":"Turk. 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