{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T14:08:29Z","timestamp":1788530909964,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"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":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Refluxate volume and pH drop following gastroesophageal reflux are mostly cleared by peristalsis. We evaluated the roles of primary volume clearing peristaltic wave (VCPW), secondary VCPW, post\u2010reflux swallow\u2010induced peristaltic wave (PSPW), and late primary peristaltic wave (LPPW) in refluxate clearance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed pH\u2010impedance studies performed off therapy in 40 patients with typical esophageal symptoms. Mechanism of refluxate clearance was evaluated for each reflux episode (primary VCPW vs. secondary VCPW vs. none), as well as presence of PSPW, LPPW when PSPW was absent, and pH recovery with each mechanism. Per\u2010episode and per\u2010patient analyses determined the dominant mechanism of refluxate clearance and pH recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 958 reflux episodes, 88% were acidic. A primary VCPW was the dominant mechanism for volume clearance (48.4% acid, 47.8% non\u2010acid reflux episodes), and \u2265\u200950% pH recovery (58.7%). Of reflux episodes lacking pH recovery, PSPW resulted in \u2265\u200950% pH recovery in 40.2%, and LPPW in 60.9%. In logistic regression models, primary peristaltic wave (primary VCPW, PSPW, or LPPW) had the highest likelihood of pH recovery in per\u2010episode analysis (OR 2.1, CI 1.3\u20133.0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and in per\u2010patient analysis (OR 11.0, CI 1.5\u201320.5, <jats:italic>p<\/jats:italic>\u2009=\u20090.025), among which primary VCPW was the most effective (OR 3.4, CI 1.5\u20137.7, <jats:italic>p<\/jats:italic>\u2009=\u20090.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A primary peristaltic wave from a swallow, either in the form of a VCPW, PSPW, or LPPW, is the dominant mechanism of pH recovery after gastroesophageal reflux. When a primary VCPW does not correct pH drop, PSPW, and LPPW are equivalent salvage mechanisms for pH recovery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.15001","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T10:57:40Z","timestamp":1736506660000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Primary Peristalsis Is the Dominant Mechanism of Refluxate Clearance Following Gastroesophageal Reflux"],"prefix":"10.1111","volume":"37","author":[{"given":"Lorenzo","family":"Marchetti","sequence":"first","affiliation":[{"name":"Department of Digestive Diseases Campus Bio Medico University of Rome  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  St Louis Missouri USA"},{"name":"Division of Gastroenterology, Hepatology, and Nutrition University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7214-5901","authenticated-orcid":false,"given":"Amit","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Duke University School of Medicine and the Durham Veterans Affairs Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4894-0523","authenticated-orcid":false,"given":"Daniel","family":"Sifrim","sequence":"additional","affiliation":[{"name":"Wingate Institute Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. Prakash","family":"Gyawali","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(97)70025-8"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-304269"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00630.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.09.047"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198402023100503"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(83)90015-X"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-199407000-00006"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm19115"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.6.784"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.09.002"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12080"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2014.06.003"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(88)90612-9"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13104"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14024"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.33.12.1590"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(05)80058-0"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-024-08315-x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.06.026"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13116"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2014.03.005"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/17562848231179329"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-322627"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-020-01732-5"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2023-330616"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000627"}],"container-title":["Neurogastroenterology &amp; Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.15001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T15:51:25Z","timestamp":1744645885000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.15001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,10]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1111\/nmo.15001"],"URL":"https:\/\/doi.org\/10.1111\/nmo.15001","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,10]]},"assertion":[{"value":"2024-11-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15001"}}