RA06.01: PATHOLOGICAL IMPLICATIONS OF SWALLOW-ASSOCIATED TRANSIENT LOWER ESOPHAGEAL SPHINCTER ELEVATION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 29-30
Author(s):  
Takahiro Masuda ◽  
Balazs Kovacs ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
Hiatal Hernia ◽  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Total Acid ◽  
High Resolution Manometry ◽  
Demeester Score ◽  
Distal Esophageal Acid Exposure ◽  
Esophageal Sphincter ◽  
End Stage

Abstract Background We have previously reported that swallow-induced transient hiatal hernia (tHH) is associated with pathological gastroesophageal reflux. In this study, we built upon our previous study of tHH, assessing the pathological implications of swallow-induced tHH in a new, larger cohort. Methods We queried a prospectively maintained database to identify patients who underwent both 24-hour pH monitoring and high-resolution manometry (HRM) between January 2017 and December 2017. We excluded patients with end-stage lung disease, inadequate LES relaxation, major esophageal motility disorders, or manometric hiatal hernia. Significant swallow-induced LES–CD separation was defined as ≥ 1 cm separation in ≥ 30% swallows or ≥ 2 cm separation in ≥ 10% swallows. We used HRM to separate patients into 3 groups, as follows: 1. Persistent tHH (p-tHH): Significant LES–CD separation at the 2nd inspiration after the conclusion of swallow-induced esophageal peristalsis. 2. Incident tHH (i-tHH): Significant LES–CD separation at the 1st inspiration after the conclusion of peristalsis without meeting p-tHH criterion. 3. Non-tHH: Neither p-tHH nor i-tHH was observed. Results In total, 472 patients underwent both HRM and a 24-hour pH study during the study period. Of these, 74 patients met inclusion criteria. The mean age was 51.6 years, and 45 patients (60.8%) were women. Forty-two patients (56.8%) had an abnormal DeMeester score (ie, > 14.72). Fourteen patients (18.9%) were categorized into the p-tHH group, 36 (48.6%) were in the i-tHH group, and 24 (32.4%) were in the non-tHH group. LES pressure, LES pressure integral, esophageal peristaltic vigor, and prevalence of dysmotility were similar among the groups. No significant differences were observed in the pH studies for patients with i-tHH and non-tHH; however, patients in the p-tHH group had a higher prevalence of abnormal DeMeester score and longer total acid reflux time than patients in the non-tHH cohort (78.6 vs 45.8%, P < 0.05; 8.0 vs 3.8%, P = 0.016, respectively). Conclusion We confirm that p-tHH is associated with pathological distal esophageal acid exposure and appears to be an early indicator of LES dysfunction. Disclosure All authors have declared no conflicts of interest.

GERD: Presence and Size of Hiatal Hernia Influence Clinical Presentation, Esophageal Function, Reflux Profile, and Degree of Mucosal Injury

2018 ◽  
Vol 84 (6) ◽  
pp. 978-982 ◽  
Author(s):  
Francisco Schlottmann ◽  
Ciro Andolfi ◽  
Fernando A. Herbella ◽  
Fabrizio Rebecchi ◽  
Marco E. Allaix ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Ph Monitoring ◽  
Mucosal Injury ◽  
Acid Reflux ◽  
Barium Swallow ◽  
Consecutive Series ◽  
Esophageal Function ◽  
High Resolution Manometry ◽  
Appropriate Therapy ◽  
Esophageal Sphincter

A hiatal hernia (HH) is a frequent finding in patients with gastroesophageal reflux disease (GERD). We examined a consecutive series of patients with GERD diagnosed by a 24-hour pH monitoring. Based on the presence and size of HH on barium swallow, patients were divided into the following groups: no HH, HH <3 cm, HH 3–5 cm and HH >5 cm. A total of 175 patients were included: 43 with no HH, 86 with HH <3 cm, 34 with HH 3–5 cm, and 12 with HH >5 cm. Patients with larger HH had more frequent episodes of coughing and wheezing associated with episodes of reflux. High-resolution manometry showed that the increasing size of the HH was associated with decreasing pressure of the lower esophageal sphincter and weaker peristalsis. Ambulatory pH monitoring revealed that patients with larger HH had more acid reflux, in both the distal and proximal esophagus. Endoscopy showed that patients with larger HH had more severe esophagitis. Fifty per cent of patients with HH >5.0 cm had Barrett's esophagus. These findings should guide gastroenterologists and surgeons in choosing the appropriate therapy in patients with GERD and large HH.

PS01.008: LOWER ESOPHAGEAL SPHINCTER PRESSURE (LESP) AS A MEASURE OF ANTI-REFLUX BARRIER IN PATIENTS WITH HIATUS HERNIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 51-52
Author(s):  
Balazs Kovacs ◽  
Takahiro Masuda ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Hiatus Hernia ◽  
Conflicts Of Interest ◽  
Holding Time ◽  
Sphincter Pressure ◽  
Total Acid ◽  
Inversion Point ◽  
Type C ◽  
Esophageal Sphincter

Abstract Background Hiatus Hernia (HH), with its anatomical/physiological derangement of esophagogastric junction (EGJ) barrier function is a risk factor for pathological gastro-esophageal reflux (GER). However, a subset of patients with HH do not have reflux. The aim of this study is to explore Lower Esophageal sphincter parameters and GER across the EGJ in patients with manometeric type C hiatal hernia (LES-Crural Diaphragm separation > 1cm, and Pressure Inversion Point below LES). Methods An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients who underwent High Resolution Manometry and 24h pH study (within 1 week) between 11/01/2016 and 11/01/2017. HRM characteristics of the EGJ (LES-CD separation, overall length, LESP, LESPI), 24 hour pH score, and pH < 4 holding time were extracted. Spearman's Rho correlation was calculated for all parameters and Receiver operating characteristic (ROC) curve was applied for parameters with significant correlation. Results A total of 1139 patients underwent HRM during the study period, of these 416 also had 24 hour pH study. 76 Patients met criteria for EGJ morphology Type C. After excluding patients with major disorders of peristalsis (16) the remaining 60 patients form the cohort of this study. Hiatal hernia size, overall length of LES, and LESPI did not correlate with 24 hour pH score or pH < 4 holding time. LESP had a significant negative correlation both with 24 hour pH score (R: -0.322; P = 0.011), and total acid holding time (R: -0.348; P = 0.006). A LESP cut-off value of 24.4 mmHg had a sensitivity of 53.8% and a Specificity of 91.2% for predicting pathological reflux. Conclusion A higher LESP (> 24.4 mmHg) appears to provide an effective barrier to pathological GER even when normal EGJ function is compromised by a hiatal hernia. Disclosure All authors have declared no conflicts of interest.

PS01.021: SHORT POEM GUIDED BY ENDOFLIP RESULTS IN LESS REFLUX RATE IN PATIENTS SUFFERING FROM ACHALASIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 56-56
Author(s):  
Lavinia Barbieri ◽  
Andrei Ilczysyn ◽  
Jafar Jafari ◽  
Abraham Botha ◽  
Edel Smyth
Keyword(s):  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Symptom Relief ◽  
High Resolution Manometry ◽  
Historic Control ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter ◽  
Long Myotomy

Abstract Background Peroral Endoscopic Myotomy (POEM) has gained ground for achalasia tratment. Although laparoscopic Heller's-Dor (LHD) is a proven intervention, the cut of the inner muscular layer during POEM offers a goal-directed procedure. However, concerns regarding post-procedure reflux had been raised. As during POEM long myotomy is generally adviced, we decreased the length to reduce reflux after treatment. Methods 19 patients with type 1 or 2 achalasia underwent POEM guided intraoperatively by Endoflip® (Crospon Ltd., Galway, Ireland) to target the myotomy where the major point of tightness was. We aimed for an increase of compliance and distensibility of three times of the lower esophageal sphincter (LOS) via a short myotomy. We compared these patients with a historic control LHD group of 15 patients in terms of Eckardt's score, GERD-HRQL questionnaire, high-resolution manometry to check pressure of the LOS 24h pH-impedence to measure acid exposure with minimum follow-up of 9 months. Results Length of myotomy was 7 cm (6–10) for POEM and 9 cm for LHD. Median Eckard's score after POEM was 0.5 versus 2 for LHD group. Median Eckardt's score and GERD-HRQL were 0.5 vs 2 and 13 vs 15, respectively after POEM or LHD. 24h pH-monitoring revealed pathologic reflux in one patient after POEM and in 3 after LHD, with median acid % time of 0,1 vs 1,2. Data are summarized in table. Conclusion POEM is effective in achieving symptom relief in patient with achalasia. Although randomized data are not available, reflux rate after POEM with short myotomy guided by Endoflip is comparable with LHD and lower than the data of literature. Disclosure All authors have declared no conflicts of interest.

PS01.009: COMPREHENSIVE CLASSIFICATION FOR ANTIREFLUX FUNCTION OF THE ESOPHAGOGASTRIC JUNCTION BASED ON HIGH-RESOLUTION MANOMETRY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 52-52
Author(s):  
Takahiro Masuda ◽  
Balazs Kovacs ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Total Acid ◽  
High Resolution Manometry ◽  
Demeester Score ◽  
Cumulative Score ◽  
The Mean

Abstract Background The anatomical configuration of the esophagogastric junction (EGJ) and the thoracoabdominal pressure gradient (TAPG) affect gastric content backflow into the esophagus. A comprehensive antireflux function assessment is needed to identify underlying derangements in patients with gastroesophageal reflux (GER). Herein we propose an objective scoring system for grading EGJ function. Methods We analyzed patients who underwent 24-hour pH study and high-resolution manometry in 2017 at our institution. We assessed three factors: EGJ morphology, lower esophageal sphincter pressure integral, and TAPG. Each factor was scored on a scale of 0–2, and a cumulative score was calculated (Table 1). Patients were divided into 3 groups based on cumulative score: 0, competent EGJ function (Grade I); 1–3, moderate incompetency (Grade II); 4–6, poor competency (Grade III). Results In total, 140 patients were studied. The mean age was 58.6 years, 75 patients (53.6%) were men, and the mean body mass index was 28.6 kg/m2. Fifty-one patients (36.4%) had an abnormal DeMeester score (ie, > 14.72). A significant, progressive increase was seen in number of reflux episodes (I-25.7, II-36.4, III-50.5, rs = 0.207, P = 0.015), total acid exposure time (I-1.0%, II-2.1%, III-5.0%, rs = 0.312, P < 0.001) and prevalence of abnormal pH score (I-13.0%, II-32.0%, III-57.1%, rs = 0.314, P < 0.001) from Grade I to III. Conclusion The proposed grading of the EGJ based on a cumulative score of individual parameters has a good correlation with GER. Disclosure All authors have declared no conflicts of interest.

scholarly journals Objective Evidence of Gastro-Esophageal Reflux Disease is Rare in Patients with Autoimmune Gastritis

2021 ◽  
Vol 30 (1) ◽  
pp. 30-36
Author(s):  
Valentina Pilotto ◽  
Gemma Maddalo ◽  
Costanza Orlando ◽  
Matteo Fassan ◽  
Massimo Rugge ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Serum Biomarkers ◽  
Functional Heartburn ◽  
High Resolution Manometry ◽  
Reflux Symptoms ◽  
Objective Evidence ◽  
Rome Iv

Background and Aims: Patients with autoimmune atrophic gastritis (AAG) often complain of acid reflux symptoms, despite the evidence of hypo-achlorhydria. Rome IV criteria are used to define functional esophageal disorders. Our aim was to characterize gastroesophageal reflux disease (GERD) phenotypes in patients with AAG. Methods: Between 2017-2018, 172 AAG patients were evaluated at Gastro-Oncology outpatient clinic of University of Padua. Of them, 38 patients with reflux symptoms underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring (MII-pH). Seventy-six AAG consecutive patients asymptomatic for gastroesophageal reflux were selected as age and gender matched controls. Serum biomarkers (pepsinogens, gastrin-17 and Helicobacter pylori antibodies), upper endoscopy, histology and clinical data were compared. Results: Out of 38/172 (22%) AAG patients with reflux symptoms, 2/38 had a GERD diagnosis based on abnormal esophageal acid exposure and 6/38 had a major motility disorder (i.e. outflow obstruction). Among the 30/38 patients with normal endoscopic findings, 9/30 had reflux hypersensitivity, 19 functional heartburn, 1 functional globus, 1 functional chest pain according to the Rome IV criteria. Antral atrophy, advanced corpus atrophy and OLGA stage were more frequent in controls than in reflux patients (p=0.01, p=0.031, p=0.01, respectively). No differences were found for serum biomarkers and symptom presentation. Most of the patients received proton pump inhibitors (PPIs) treatment (87%), with a minority (34%) reporting clinical benefit. Conclusions: Reflux symptoms are relatively common in AAG patients, but a firm diagnosis of GERD is rare (5%), whereas most of the patients have a functional disorder. PPI treatment is mostly clinical ineffective and should not be largely indicated.

scholarly journals Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Marianne Clément ◽  
Wen Jing Zhu ◽  
Elissaveta Neshkova ◽  
Mickael Bouin
Keyword(s):  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Ph Monitoring ◽  
Motility Disorder ◽  
Study Patient ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Gastrointestinal Motility Disorder ◽  
Esophageal Sphincter ◽  
Age And Sex

Background. Jackhammer esophagus is a hypercontractile esophageal disorder recently brought to light with the advent of high resolution manometry (HRM). As little is known about its clinical presentation, the aim of this study was to identify the clinical characteristics associated with this new gastrointestinal motility disorder. Methods. A retrospective study was conducted on patients visiting the CHUM’s Gastro-Intestinal Motility Center from January 2015 to December 2017. The HRM diagnoses were collated in a database along with age and sex of every individual. The latest Chicago classification (version 3.0) was used. Among all the patients subjected to HRM, those diagnosed with Jackhammer esophagus were included in the study. Patient charts were reviewed to collect relevant demographic and clinical data. Key Results. A total of 36 patients with Jackhammer esophagus were included (62 ± 13 years age, 89% females). Their main symptoms were dysphagia (72%), pyrosis (42%), retrosternal chest pain (36%), and epigastralgia (33%). Other manometric findings were hypertonia (22%) and/or inadequate relaxation (19%) of the lower esophageal sphincter. Among the 26 patients who had esogastroduodenoscopy, hiatal hernia was seen in 3 patients. Pathological gastroesophageal reflux was found in 4 of the 10 patients investigated by pH-monitoring. Conclusions and Inferences. Jackhammer esophagus represents 3% of the HRM diagnoses in this study, with a significant female preponderance. In more than two-thirds of cases, the clinical presentation of Jackhammer esophagus is dysphagia.

scholarly journals Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results

2020 ◽  
Author(s):  
Miloš Bjelović ◽  
László Harsányi ◽  
Áron Altorjay ◽  
Zsolt Kincses ◽  
Peter Forsell
Keyword(s):  
Adverse Events ◽  
Clinical Investigation ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Total Acid ◽  
Serious Adverse Events ◽  
Hrql Score ◽  
New Device ◽  
Dynamic Treatment

Abstract BACKGROUND RefluxStop™ is an implantable, non-active, single use device to be used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected. METHODS In prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD had been included. They were operated using standardized surgical technique between December 2016 and September 2017 and followed up for one year (CE-mark investigation 6-months). Primary safety outcome was the prevalence of serious adverse events related to the device and primary effectiveness outcome reduction of GERD symptoms based on the GERD HRQL score. Secondary outcomes were the prevalence of the adverse events apart from serious, reduction of the total acid exposure time on 24-hour pH monitoring, reduction in average daily PPI dosage and subject satisfaction. RESULTS There were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p<0.001). 24-h pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH<4 from 16.35% to 0.80% at the 6-month visit (p<0.001). At 1-year: No new cases of dysphagia were recorded, occurred in 2 subjects, both significantly reduced compared to baseline. Regular daily PPI use before surgery occurred in all 50 subjects. At the 1-year follow-up only 1 subject took regular daily PPIs due to too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects. CONCLUSION The new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow up visit, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced.

scholarly journals Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results

2020 ◽  
Author(s):  
Miloš Bjelović ◽  
László Harsányi ◽  
Áron Altorjay ◽  
Zsolt Kincses ◽  
Peter Forsell
Keyword(s):  
Adverse Events ◽  
Clinical Investigation ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Total Acid ◽  
Serious Adverse Events ◽  
Hrql Score ◽  
New Device ◽  
Dynamic Treatment

Abstract BACKGROUND RefluxStop™ is an implantable, non-active, single use device used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original, anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected. METHODS In a prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD were operated using a standardized surgical technique between December 2016 and September 2017. They were followed up for one year (CE-mark investigation 6-months). Primary safety outcome was prevalence of serious adverse events related to the device, and primary effectiveness outcome reduction of GERD symptoms based on GERD-HRQL score. Secondary outcomes were prevalence of adverse events other than serious adverse events, reduction of total acid exposure time in 24-hour pH monitoring, and reduction in average daily PPI usage and subject satisfaction. RESULTS There were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p<0.001). 24-hour pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH<4 from 16.35% to 0.80% at the 6-month visit (p<0.001), with 98% of subjects showing normal 24-hour pH. At 1 year: No new cases of dysphagia were recorded, present in 2 subjects, which existed already at baseline. Regular daily PPI usage occurred in all 50 subjects at baseline. At 1-year follow-up, only 1 subject took regular daily PPIs due to a too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects.CONCLUSION The new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow-up, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced.

GERD: Clinical Solutions of Problems in General Practice

2016 ◽  
pp. 125-128
Author(s):  
Viacheslav Chernobroviy ◽  
Serhii Melashchenko ◽  
Oleh Ksenchyn
Keyword(s):  
Gastric Secretion ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Acid Exposure ◽  
Total Acid ◽  
Esophageal Ph ◽  
Different Types ◽  
Gastric Ph Monitoring ◽  
The Difference ◽  
Concomitant Hypertension

The objective: To explore the features of acid level and aggravation in stomach and esophagus in patients with isolated GERD, hypertension and their comorbidity. Patients and methods. For this study were selected 4 groups: group of patients with GERD, a group of patients with hypertension, the group of patients with comorbid hypertension and GERD and group without GERD and hypertension (total 78 patients). To all patients were performed 3-channel gastro esophageal pH monitoring. In our case, we conducted a 3-hour version of the survey with standardized provoking breakfast. All patients underwent assessment of gastric secretion by original integrative indicators that reflect basal pH, number of different types of refluxes, duration of alkalization in stomach after meal. Results. GERD patients with hypertension and without are demonstrating an equal number of acid and all (nonacid + acid) reflux which is 18,9 against 19,8 (p>0,05). But the difference between the two groups was that in patients with concomitant hypertension observed longer refluxes 309,3 to 179,1 (p<0,05) and a total acid exposure tends to be prolonged – 25,9 to 20,9 (p>0,05). Our analysis of the state of gastric secretion on the results of 2001 minute intra gastric pH monitoring, showed as expected more intensive acid in both groups of patients with GERD. The most «acidic» patients were GERD patients with hypertension, but compared with similar patients without hypertension, the difference was false due to the relatively small size of the samples. Conclusion. Comorbidity of GERD and hypertension is characterized by severe pathological dysmotility in the lower third of the esophagus, unlike isolated GERD, which affects the increase in acid exposure and susceptibility to long reflux. A factor that may add to burden of GERD in combination with hypertension may be gastric hyperacidity and a clear predisposition to obesity.

PS01.003: EVALUATION OF BOTH STANDARD AND NOVEL HRM METRICS OF THE UPPER ESOPHAGEAL SPHINCTER (UES) IN ACHALASIA AND REFLUX DISEASE. APPLICATION OF THE CONTRACTILE INTEGRAL IN THE UES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 50-50
Author(s):  
Tania Triantafyllou ◽  
Charalampos Theodoropoulos ◽  
Georgios Zografos ◽  
Dimitrios Theodorou
Keyword(s):  
Conflicts Of Interest ◽  
Neuronal Damage ◽  
Upper Esophageal Sphincter ◽  
Control Group ◽  
Residual Pressure ◽  
Study Group ◽  
High Resolution Manometry ◽  
Esophageal Lumen ◽  
Resting Pressure ◽  
Esophageal Sphincter

Abstract Background The literature is still lacking thorough manometric analysis of the function of the Upper Esophageal Sphincter (UES) among patients with motility disorders. Assessment of the High Resolution Manometry (HRM) features of the UES may be the key in further understanding the manometric profile of achalasia and even predicting treatment outcome. Furthermore, the Contractile Integral (CI) may be a more representative measure of contractility of the UES too. Methods Achalasia patients (study group) and a control group of individuals underwent HRM. Resting pressure, residual pressure, UES length and the Landmark UES-CI corrected for respiration were analyzed and compared between the two groups. The UES-CI metric was calculated according to the method applied for the Distal Contractile Integral (DCI). Results 24 achalasia patients and 24 subjects consisting the control group with mean age 55.2 and 56.1, respectively, were enrolled. Although the mean UES length was found significantly lower in our study group (3.2 vs. 4.3, P = 0), mean residual pressure was found significantly higher among the same group as compared to controls (12.5 vs. 3, P = 0.01). Interestingly, we found a trend towards lower values of the corrected UES-CI in achalasia compared to the control group (132 vs. 207.8, P = 0.08). The resting pressure did not differ between the two groups. Conclusion Increased residual pressure values of the UES in achalasia compared to control group is a reasonable finding that indicates that UES may also be affected by the neuronal damage in this disorder or that the pressurization phenomenon (mainly in achalasia type II) disrupts the function of the UES during swallowing. However, results on the UES-CI in resting phase cannot confirm the hypothesis of higher risk of aspiration among achalasia patients whose esophageal lumen is known to present with incomplete clearance and stasis. Disclosure All authors have declared no conflicts of interest.

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