Volume 130, Issue 2, Pages 334-340 (February 2006) Intermittent Spatial Separation of Diaphragm and Lower Esophageal Sphincter Favors Acidic and Weakly Acidic Reflux  Albert J. Bredenoord, Bas L.A.M. Weusten, Robin Timmer, André J.P.M. Smout  Gastroenterology  Volume 130, Issue 2, Pages 334-340 (February 2006) DOI: 10.1053/j.gastro.2005.10.053 Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 1 Radiographic images taken during the validation study. (A) The metal clip at the squamocolumnar junction (arrow) is visible at the level of the diaphragm, located between the first and second ring on the catheter. Osteosynthesis material is present at the left humerus. (B) Radiographic image of the same subject 30 minutes after the previous image. The metal clip at the squamocolumnar junction is located proximal to the second ring on the catheter. Gastroenterology 2006 130, 334-340DOI: (10.1053/j.gastro.2005.10.053) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 2 Distance between the endoscopically placed clip and the proximal margin of the diaphragm during the single and double pressure peak periods. Gastroenterology 2006 130, 334-340DOI: (10.1053/j.gastro.2005.10.053) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 3 Contour plots of a single and double high-pressure zone configuration. In these plots, pressure amplitudes are presented in colors. A shows 1 high-pressure zone (HPZ). A dry swallow is marked with an arrow. B shows a tracing in the same patient when the proximal and distal HPZ are spatially separated. Relaxation of both components occurs during a dry swallow (arrow). The respiratory pressure variations are much larger in the distal HPZ (diaphragm). Gastroenterology 2006 130, 334-340DOI: (10.1053/j.gastro.2005.10.053) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 4 Reflux rate (episodes per hour) during the reduced (single pressure peak, open bars) and unreduced (double pressure peak, gray bars) hernia state. Significantly higher reflux rates were found during the unreduced state. *P ≤ .05. Gastroenterology 2006 130, 334-340DOI: (10.1053/j.gastro.2005.10.053) Copyright © 2006 American Gastroenterological Association Terms and Conditions

Figure 5 Mechanisms of reflux during the reduced (open bars) and unreduced (gray bars) hernia state. TLESRs were the most prevalent reflux mechanism during the reduced state. The increase in reflux rate in the unreduced state is due to other reflux mechanisms. *P ≤ .05. Gastroenterology 2006 130, 334-340DOI: (10.1053/j.gastro.2005.10.053) Copyright © 2006 American Gastroenterological Association Terms and Conditions