Reviewer's report 
 The effect of straining on the diaphragmatic crura with identification of the straining-crural Title: 
reflex. The reflex theory in gastroesophagael competence: a new concept 
 2  6 May 2004 Version: Date: 
 Ravinder K Mittal Reviewer: 
Reviewer's report: 
I have some concerns even though the reviewers have responded to most of the questions 
appropriately. One of my concern still remains which is that it is not clear what do the authors mean by a reflex response? It is clear that crural diaphragm contract during coughing and straining. If I understand correctly authors imply that this reflex originates in the crural diaphragm because when 
they inject lidocain (which blocks sensory nerve fibers) in the crural diaphragm muscle around the 
electrodes, there is a reduction in the amplitude of crural diaphragm EMG and LES pressure. How does localized anesthesia block reflex contraction during coughing and straining is not clear to this reviewer. The authors have used novel methodology and their observation that crural diaphragm 
contracts during coughing and straining is correct and worthy of publication. Either they should 
clarify the reflex more clearly or delete it from the manuscript. I am comfortable with the remainder of the paper and conclusions. 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Reviewer's report 
 The effect of straining on the diaphragmatic crura with identification of the straining-crural Title: 
reflex. The reflex theory in gastroesophagael competence: a new concept 
 2  6 May 2004 Version: Date: 
 Ravinder K Mittal Reviewer: 
Reviewer's report: 
I have some concerns even though the reviewers have responded to most of the questions 
appropriately. One of my concern still remains which is that it is not clear what do the authors mean by a reflex response? It is clear that crural diaphragm contract during coughing and straining. If I understand correctly authors imply that this reflex originates in the crural diaphragm because when 
they inject lidocain (which blocks sensory nerve fibers) in the crural diaphragm muscle around the 
electrodes, there is a reduction in the amplitude of crural diaphragm EMG and LES pressure. How does localized anesthesia block reflex contraction during coughing and straining is not clear to this reviewer. The authors have used novel methodology and their observation that crural diaphragm 
contracts during coughing and straining is correct and worthy of publication. Either they should 
clarify the reflex more clearly or delete it from the manuscript. I am comfortable with the remainder of the paper and conclusions. 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Please review this paper.
user
Reviewer's report 
 The effect of straining on the diaphragmatic crura with identification of the straining-crural Title: 
reflex. The reflex theory in gastroesophagael competence: a new concept 
 2  6 May 2004 Version: Date: 
 Ravinder K Mittal Reviewer: 
Reviewer's report: 
I have some concerns even though the reviewers have responded to most of the questions 
appropriately. One of my concern still remains which is that it is not clear what do the authors mean by a reflex response? It is clear that crural diaphragm contract during coughing and straining. If I understand correctly authors imply that this reflex originates in the crural diaphragm because when 
they inject lidocain (which blocks sensory nerve fibers) in the crural diaphragm muscle around the 
electrodes, there is a reduction in the amplitude of crural diaphragm EMG and LES pressure. How does localized anesthesia block reflex contraction during coughing and straining is not clear to this reviewer. The authors have used novel methodology and their observation that crural diaphragm 
contracts during coughing and straining is correct and worthy of publication. Either they should 
clarify the reflex more clearly or delete it from the manuscript. I am comfortable with the remainder of the paper and conclusions. 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
assistant