{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:20:36Z","timestamp":1789770036932,"version":"4.0.1"},"reference-count":33,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"accepted":{"date-parts":[[1998,7,22]]},"published-print":{"date-parts":[[1999,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Belching has been proposed as a major mechanism underlying acid gastro-oesophageal reflux in normal subjects. However, the presence of oesophageal gas has not been measured directly but only inferred from manometry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate, using intraluminal electrical impedance, the patterns of gas and liquid reflux during transient lower oesophageal sphincter (LOS) relaxations, the main mechanism of acid reflux in normal subjects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Impedance changes associated with the passage of gas were studied in vitro, and in vivo in cats. Oesophageal manometry, pH, and intraluminal electrical impedance measurements were performed in 11 normal subjects after a meal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Gas reflux caused a sudden increase in impedance that propagated rapidly to the proximal oesophagus whereas liquid reflux induced a retrogressively propagated fall in impedance. Impedance showed gas or liquid reflux during most (102\/141) transient LOS relaxations. When acid reflux occurred, impedance showed evidence of intraoesophageal retrograde flow of liquid in the majority (78%) of events. Evidence of gas retroflow was found in almost half (47%) of acid reflux episodes. When present together, however, liquid preceded gas on 44% of occasions. Overall, gas reflux occurred as the initial event in only 25% of acid reflux episodes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that in upright normal subjects, although belching can precipitate acid reflux, most acid reflux occurs as a primary event.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gut.44.1.47","type":"journal-article","created":{"date-parts":[[2010,6,30]],"date-time":"2010-06-30T12:46:12Z","timestamp":1277901972000},"page":"47-54","source":"Crossref","is-referenced-by-count":193,"title":["Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance"],"prefix":"10.1136","volume":"44","author":[{"given":"D","family":"Sifrim","sequence":"first","affiliation":[{"name":"aCentre for Gastroenterological Research, University of Leuven, Leuven, Belgium, \n\nbHelmoltz-Institute for Biomedical Engineering, Aachen, Germany, \n\ncDepartment of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Silny","sequence":"additional","affiliation":[{"name":"aCentre for Gastroenterological Research, University of Leuven, Leuven, Belgium, \n\nbHelmoltz-Institute for Biomedical Engineering, Aachen, Germany, \n\ncDepartment of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R H","family":"Holloway","sequence":"additional","affiliation":[{"name":"aCentre for Gastroenterological Research, University of Leuven, Leuven, Belgium, \n\nbHelmoltz-Institute for Biomedical Engineering, Aachen, Germany, \n\ncDepartment of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J J","family":"Janssens","sequence":"additional","affiliation":[{"name":"aCentre for Gastroenterological Research, University of Leuven, Leuven, Belgium, \n\nbHelmoltz-Institute for Biomedical Engineering, Aachen, Germany, \n\ncDepartment of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1999,1,1]]},"reference":[{"key":"2025112110340846000_44.1.47.1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI109667"},{"key":"2025112110340846000_44.1.47.2","first-page":"G636","article-title":"Characteristics of transient lower esophageal sphincter relaxation in humans.","volume":"252","author":"Mittal","year":"1987","journal-title":"Am J Physiol"},{"key":"2025112110340846000_44.1.47.3","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(95)90011-X"},{"key":"2025112110340846000_44.1.47.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198212163072503"},{"key":"2025112110340846000_44.1.47.5","doi-asserted-by":"publisher","DOI":"10.1136\/gut.29.8.1020"},{"key":"2025112110340846000_44.1.47.6","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/S0016-5085(88)80003-9","article-title":"Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis.","volume":"95","author":"Mittal","year":"1988","journal-title":"Gastroenterology"},{"key":"2025112110340846000_44.1.47.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.1996.tb00253.x"},{"key":"2025112110340846000_44.1.47.8","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(86)90449-X"},{"key":"2025112110340846000_44.1.47.9","doi-asserted-by":"publisher","DOI":"10.1136\/gut.31.6.639"},{"key":"2025112110340846000_44.1.47.10","doi-asserted-by":"publisher","DOI":"10.1136\/gut.34.4.444"},{"key":"2025112110340846000_44.1.47.11","doi-asserted-by":"publisher","DOI":"10.1136\/gut.36.4.505"},{"key":"2025112110340846000_44.1.47.12","first-page":"27","article-title":"Radiology of esophageal function and gastroesophageal reflux disease.","volume":"22","author":"Ott","year":"1994","journal-title":"Functional evaluation in esophageal disease. 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