{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:13:03Z","timestamp":1784203983208,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastroesophageal reflux disease (GERD) arises from dysfunction of the anti\u2010reflux barrier. While high\u2010resolution manometry (HRM) is routinely performed in suspected GERD, traditional metrics are poor predictors. The routine adoption of the straight leg raise (SLR) maneuver has unveiled a series of unaddressed challenges. This study aimed to determine the minimum intra\u2010abdominal pressure (IAP) increase for effectively stressing the esophago\u2010gastric junction (EGJ), the optimal intra\u2010esophageal pressure (IEP) increase threshold for GERD prediction, and explore EGJ behavior in GERD and non\u2010GERD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective review of HRM tracings and pH\u2010impedance studies of consecutive adult patients with GERD symptoms. Peak and mean IAP and IEP during the reference period and SLR were recorded. The SLR was effective if the EGJ\u2010contractile integral (EGJ\u2010CI) during the maneuver increased by 50% compared to baseline. GERD was diagnosed based on Lyon 2.0. The optimal thresholds for effective and positive SLR were determined using the receiver operator characteristics analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 298 patients included (53% females, age 52\u2009years, BMI 24\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), 145 had GERD. A delta mean IAP increase of 15.4\u2009mmHg best predicted effective EGJ challenge (AUC 0.825). A delta peak IEP increase of 11.4\u2009mmHg optimally predicted GERD (AUC 0.777), aligning with the prior threshold (11\u2009mmHg). Non\u2010GERD patients exhibited higher EGJ\u2010CI during SLR, reflecting intact anti\u2010reflux barrier function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The SLR maneuver enhances GERD diagnosis in HRM by dynamically assessing EGJ competence. Our study validated the thresholds to define an effective (mean IAP increase of 15.4\u2009mmHg) and positive (peak IEP increase of 11.4\u2009mmHg) maneuver.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70102","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T01:14:07Z","timestamp":1749777247000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Optimizing the Straight Leg Raise Maneuver to Improve Prediction of Conclusive Gastro\u2010Esophageal Reflux Disease"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0532-3135","authenticated-orcid":false,"given":"Stefano","family":"Siboni","sequence":"first","affiliation":[{"name":"Division of General and Emergency Surgery, IRCCS Policlinico San Donato, Milano University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Galdino","family":"Riva","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery, IRCCS Policlinico San Donato, Milano University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"De Maron","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery, IRCCS Policlinico San Donato, Milano University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Sozzi","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery, IRCCS Policlinico San Donato, Milano University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-5301","authenticated-orcid":false,"given":"Pierfrancesco","family":"Visaggi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Traslational Research and New Technologies University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology University of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Asti","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery, IRCCS Policlinico San Donato, Milano University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. 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