Background and Aims: Transient lower esophageal sphincter relaxation (TLESR) is frequently associated with reflux events and terminates with a primary or secondary peristaltic wave. However, it is unclear whether the presence and properties of the refluxate affect TLESR termination events. The aims of this study were to determine the pattern of terminating esophageal motor activity after TLESR in healthy subjects, and factors affecting the type of terminating motor event. Methods: Fifteen healthy subjects (7M, age 18-56) were studied. High-resolution manometry and impedance-pH monitoring were performed simultaneously in supine position for 2 hours after taking 1000 kcal meal (Awake Study). This procedure was repeated during night under polysomnographic recording for 6-8 hours after consuming a 1000 kcal meal (Sleep Study). We categorized three types of TLESR terminating motor events: primary peristalsis (PP), full secondary contraction (FSC) which propagated the entire esophagus and partial secondary contractions (PSC) which started distal to the UES. Results: Overall, 289 TLESR events were found. The percentages of TLESR events terminated by PP, FSC and PSC were 22%, 14% and 64%, respectively. TLESR events terminated by PP were less likely to be accompanied by reflux events. TLESR events terminated by FSC were significantly more likely to have evidence for proximal esophageal reflux and esophago-pharyngeal reflux. Findings were similar in awake and sleep states. Conclusion: In healthy recumbent subjects, the most common TLESR termination event is a secondary contraction, rather than primary peristalsis. Presence and distribution of the refluxate is a major influence on the type of terminating contraction.