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Because the diagnostic sensitivity and reliability of conventional impedance\u2010pH variables are suboptimal, several novel impedance parameters, such as the postreflux swallow\u2013induced peristaltic wave index and the mean nocturnal baseline impedance, as well as mucosal impedance, are entering a validation stage prior to general clinical use. The accurate diagnosis of behavioral disorders in patients with rumination syndrome and supragastric belching using ambulatory multiple intraluminal impedance\u2010pH can lead directly to behavioral interventions in patients with refractory gastroesophageal reflux disease (GERD). New provocative measures, such as multiple rapid swallows and the rapid drink challenge, have been developed to overcome the limitations of standard high\u2010resolution esophageal manometry, aiming at further clarifying esophageal dysmotility. Furthermore, the current diagnostic and therapeutic challenges in patients with esophageal involvement in Sjogren's syndrome and scleroderma, who tend to have severe forms of GERD, are entering a new investigative and clinical phase.<\/jats:p>","DOI":"10.1111\/nyas.14424","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T00:47:37Z","timestamp":1593996457000},"page":"170-181","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["New developments in esophageal function testing and esophageal manifestations of connective tissue disorders"],"prefix":"10.1111","volume":"1481","author":[{"given":"Junichi","family":"Akiyama","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology National Center for Global Health and Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junko","family":"Sumida","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology National Center for Global Health and Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichiro","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Masamune","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navapan","family":"Issariyakulkarn","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology King Chulalongkorn Memorial Hospital  Thai Red Cross Society Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanisa","family":"Patcharatrakul","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology King Chulalongkorn Memorial Hospital  Thai Red Cross Society Bangkok Thailand"},{"name":"Center of Excellence in Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine Chulalongkorn University  Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katerina","family":"Shetler","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Palo Alto Medical Foundation  Mountain View California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiko","family":"Kuribayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Maebashi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshio","family":"Uraoka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine  Maebashi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Triadafilopoulos","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.444"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2008.01131.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.03039.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.07.009"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.07.010"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.08.029"},{"key":"e_1_2_7_8_1","first-page":"1900","article-title":"Impedance\u2010pH monitoring for diagnosis of reflux disease: new perspectives","volume":"101","author":"Frazzoni M.","year":"2017","journal-title":"Dig. 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