{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T12:29:12Z","timestamp":1754396952311,"version":"3.41.2"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T00:00:00Z","timestamp":1603843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The mechanisms associated with gastro\u2010esophageal reflux (GER) episodes were studied using combined High\u2010resolution Impedance Manometry (HRIM) and pH monitoring in ambulant subjects with different patterns of GERD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixteen subjects with mild\u2010moderate esophagitis (Los Angeles (LA) grade A&amp;B) (group A) and 11 subjects with severe esophagitis (LA grade C&amp;D) or Barrett's esophagus (BE) were studied before and after a meal, resting, while walking, and during standardized exercise, using a HRIM and a pH probe.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Post\u2010prandial acid GER episodes were more common in group B (median 10 range (3\u201018) vs A (6.5 (0\u201018), <jats:italic>p<\/jats:italic>\u00a0=\u00a00.048). Postprandial acid clearance time was much longer in group B (median 0.71( 0.07\u20102.66\u00a0min) vs A (0.17 (0.04\u20102.44 min), <jats:italic>p<\/jats:italic>\u00a0=\u00a00.02). Transient lower esophageal sphincter relaxation (TLESR) was the most frequent mechanism associated with GER episodes in both groups. Post\u2010prandial TLESRs with GER were more common in group B (median 17 (9\u201024) vs A 13.5 (7\u201034), <jats:italic>p<\/jats:italic>\u00a0=\u00a00.014), particularly during exercise (B 8 (6\u20109) vs A 6 (5\u20106.8), <jats:italic>p<\/jats:italic>\u00a0=\u00a00.007). Post\u2010prandially TLESR with acid reflux increased during exercise in both groups (A rest median 2.4 (0\u20106.4) per hour vs exercise 4.7 (0\u201017.3), <jats:italic>p<\/jats:italic>\u00a0=\u00a00.005 and B 4 (0.8\u20109.6) vs 5.3 (2.7\u201013.3) per hour, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.045).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>TLESR was the most common mechanism associated with reflux episodes in all subjects. Acid reflux episodes were more common in subjects with severe esophagitis or BE and esophageal acid clearance was much slower. Post\u2010prandial exercise increased TLESR with acid reflux and GERD patients should be encouraged to avoid exercise immediately after a meal.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14023","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T11:40:29Z","timestamp":1603885229000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The mechanisms associated with reflux episodes in ambulant subjects with gastro\u2010esophageal reflux disease"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9568-0680","authenticated-orcid":false,"given":"Paola","family":"Iovino","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Sandwell &amp; West Birmingham Hospitals NHS Trust Lyndon West Bromwich UK"},{"name":"Department of Medicine, Surgery and Dentistry \u201cScuola Medica Salernitana\u201d University of Salerno Baronissi Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0172-6570","authenticated-orcid":false,"given":"Byron","family":"Theron","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sandwell &amp; 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