Running is the most popular form of exercise in the United States. Gastroesophageal reflux (GER) is common during exercise and may affect performance. Previous studies have focused on increased intra-abdominal pressure as a major determinant of acid reflux during physical exertion. In this issue, Herregods et al. examined the mechanisms of GER in healthy volunteers using simultaneous high-resolution manometry and pH impedance testing performed while running. Novel observations afforded by the utilization of state-of-the-art technology include the importance of transient lower esophageal sphincter relaxation ("belch reflex") and transient formation of hiatal hernia during exercise. The findings are provocative and lend credence to commonsense strategies to minimize the consequences of belching in runners.
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