{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:26:40Z","timestamp":1790756800959,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,12,10]],"date-time":"2015-12-10T00:00:00Z","timestamp":1449705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>While high resolution esophageal manometry combined with impedancometry has demonstrated that gastric pressurizations lead to rumination, the contribution of upper esophageal sphincter (UES) and esophagogastric junction (<jats:styled-content style=\"fixed-case\">EGJ<\/jats:styled-content>) function to rumination is unclear. Behavioral therapy with diaphragmatic breathing (DB) can reduce rumination. We aimed to evaluate the pressures in the stomach, <jats:styled-content style=\"fixed-case\">EGJ<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">UES<\/jats:styled-content> during rumination and the effects of DB augmented with biofeedback therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixteen patients with rumination were studied with manometry and impedancometry before and after a meal. The postprandial assessment comprised three periods: before, during, and after DB augmented with biofeedback therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>All patients had postprandial rumination, which was associated (<jats:italic>p<\/jats:italic> &lt; 0.001) with increased gastric pressure and reversal of the postprandial gastroesophageal pressure gradient from \u22124 (\u221243 to 18) before to 20 (7\u201379) mmHg during rumination. The <jats:styled-content style=\"fixed-case\">EGJ<\/jats:styled-content> pressure was lower (<jats:italic>p<\/jats:italic> &lt; 0.001) during gastric pressurizations that were associated with rumination <jats:italic>vs<\/jats:italic> those that were not. The <jats:styled-content style=\"fixed-case\">UES<\/jats:styled-content> also relaxed, almost completely, during rumination. Patients had a median (range) of 5 (2\u201310) rumination episodes before, 1 (0\u20132) (<jats:italic>p<\/jats:italic> &lt; 0.001) during, and 3 (1\u20135) after (<jats:italic>p<\/jats:italic> &lt; 0.001 <jats:italic>vs<\/jats:italic> during) diaphragmatic breathing. During manometry and impedancometry, DB was well\u2010tolerated and learned within 5 min. Diaphragmatic breathing increased <jats:styled-content style=\"fixed-case\">EGJ<\/jats:styled-content> pressure (<jats:italic>p<\/jats:italic> &lt; 0.001) and restored a negative gastroesophageal pressure gradient (\u221220 mmHg [\u221280 to 7]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>Diaphragmatic breathing aided with high resolution esophageal manometry is well\u2010tolerated, effective and averts the gastroesophageal pressure disturbance that leads to rumination.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.12737","type":"journal-article","created":{"date-parts":[[2015,12,11]],"date-time":"2015-12-11T03:23:07Z","timestamp":1449804187000},"page":"384-391","source":"Crossref","is-referenced-by-count":97,"title":["Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action"],"prefix":"10.1111","volume":"28","author":[{"given":"M.","family":"Halland","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Parthasarathy","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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