Tu1272 IMPACT OF GABA-B AGONIST BACLOFEN ON ESOPHAGEAL MOTILITY IN HUMANS USING HIGH RESOLUTION MANOMETRY Chien-Lin Chen, Chih-Hsun Yi, Tso-Tsai Liu, Wei-Yi Lei, Jui-Sheng Hung, Ming-Wun Wong Objective: Baclofen inhibited transient relaxation of lower esophageal sphincter (LES) and increased resting LES pressure. The aim of our study is to investigate the effect of baclofen on esophageal peristaltic activities and reserve in healthy adults by using high resolution manometry (HRM). Methods: All subjects (12 men, age 21-39, mean 27 years) underwent HRM with 10 water swallows and 5 multiple rapid swallows 90 minutes after oral intake of baclofen 40 mg or the placebo on separate days at least 1 week apart with double-blind in randomized order. The HRM parameters included esophagogastric junction contractile integral (EGJ-CI), resting LES pressure, 4-second integrated relaxation pressure (4-s IRP), latency, distal contractile integral (DCI), resting upper esophageal sphincter pressure (UESP) and the response to MRS. Results: Baclofen significantly increased EGJ-CI (p = 0.007), 4- s IRP (p = 0.003) and LES pressure (p = 0.004). There was no difference in UESP (p = 0.87) between baclofen and the placebo. Latency and DCI were similar between baclofen and the placebo (p = 0.84 and p = 0.54, respectively). There was no difference in contractile response and peristaltic augmentation following MRS between baclofen and the placebo (93% vs. 100%, p = 0.30; 53% vs. 73%, p = 0.26). Conclusions: By using HRM, we have demonstrated that baclofen increases EGJ barrier function, resting LES pressure and the relaxation of LES, but had effect on resting pressure of UES. Neither esophageal peristaltic vigor nor peristaltic reserve can be influenced by baclofen. Tu1273 ELEVATION OF BASAL EGJ PRESSURE IS ASSOCIATED WITH LOW- EFFICACY OF ACOTIAMIDE FOR THE PATIENTS WITH EGJ OUTFLOW OBSTRUCTION Eikichi Ihara, Kazumasa Muta, Xiaopeng Bai, Shohei Hamada, Hiroko Ikeda, Keishi Komori, Haruei Ogino, Takatoshi Chinen, Yoshihiro Ogawa Background and aim: EGJ outflow obstruction (EGJOO) is characterized by impaired EGJ relaxation in combination with preserved peristalsis and it could be a precursor of achalasia. We have shown that successful EGJ relaxation is achieve by combination of EGJ recessive relaxation (EGJRR) and swallow-induced EGJ relaxation (SIEGJR) (Muta K, Gastroenteroloy 2017;152;5:S320), and impaired EGJRR is the underlying pathogenesis of EGJOO. We have reported that acotiamide, which is clinically used for treatment of functional dyspepsia in Japan, restored impaired EGJRR in EGJOO in the pilot study (n=6) (Muta K, Digestion. 2016;94:9-16). The objective of this study was to determine the treatment efficacy of acotiamide for EGJOO. Methods: This was a prospective observational study. Between May 2015 and Sep 2018, 25 patients with EGJOO were enrolled in this study. The patients had been suffering from dysphasia and chest discomfort at least for 3 months and did not have spontaneous remission of symptoms. Acotiamide (300 mg/day) was applied for 4 weeks. HRM (Manoscan Z) was performed before and after the treatment of acotiamide. As for the HRM metrics, the basal EGJ pressure (BEGJP) (13-43 mmHg), IRP (<15mHg), DCI (500- 5000 mmHg*s*cm) and DL (>4.5s) were measured. The data were expressed as the median (interquartile range). Results: The median age was 64.0 (55-70) years old and FSSG (esopha- geal symptom questionnaire) was 15.0 (6.5-20) (<8). Out of 25 patients, esophageal motility function was normalized in 12 patients (effective group) while impaired EGJ relaxation was not restored in the remaining patients (ineffective group). In effective group, the BEGJP (28.9, 23.4-37.8 mmHg) and IRP (12.9, 9.3-13.9 mmHg) after treatment were significantly lower than those (38.9, 31.1-48.4 mmHg and 18.5, 16.7-20.6 mmHg, respectively) before treatment, and FSSG after treatment (9.0, 4.8-14.8) tended to be lower than that before treatment (14.5, 8.5-17.0). There were no significant differences in DCI and DL. In ineffective group, there were no significant differences in BEGJP (53.3, 42.1-65.7 v.s. 48.5, 38.8-58.7 mmHg), IRP (21.5, 17.5-29.1 v.s. 21.5, 15.9-28.0 mmHg), DCI (1868.2, 1214.0-3293 v.s. 2334.9, 689.8-6470.7 mmHg*s*cm) and DL (5.8, 4.9-6.9 v.s. 5.6, 5.3-7.3 mmHg) between before and after treatment, respectively. Next, we determined the factors before treatment associated with efficacy of acotiamide on EGJOO. The median BEGJP of ineffective group (53.3, 42.1-65.7 mmHg) was higher than upper limit of normal (43 mmHg), and it was also significantly higher than that of effective group (38.9, 31.1-48.4 mmHg) while there were no significant differences in other metrics including IRP, DCI and DL. Conclusions: acotiamide was effective for approximately 50 % of EGJOO where elevated BEGJP could be associated with low-efficacy of acotiamide for the patients with EGJOO. Tu1274 IMPACT OF PATIENT POSITION ON ESOPHAGEAL MOTILITY DISORDERS USING HIGH RESOLUTION ESOPHAGEAL MANOMETRY Samuel Tanner, Herit Vachhani, Martha J. Harrison, Zubair A. Malik, Ron Schey, Henry P. Parkman Introduction: High resolution esophageal manometry (HREM) performed with supine patient positioning is used to evaluate patients for esophageal motility disorders. However, most patients experience symptoms related to esophageal dysmotility in an upright position, such as when eating or drinking. Aim: 1) Compare HREM metrics in the supine vs. upright position for normal subjects and patients undergoing evaluation; 2) Determine if upright position alters the motility characterization of patients. Methods: HREM of normal subjects and consecutive patients between February 2018 and July 2018 without history of upper GI surgery or current use of medications that affect GI motility were included. Twelve wet swallows were performed in the supine position followed by five wet swallows in the upright position. Upper esophageal sphincter (UES) pressure, lower esophageal sphincter (LES) pressure, hiatal hernia length, esophageal length, LES length, integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency, and diagnosis based on Chicago Classifi- cation v3.0 (CC) were evaluated in each position. Results: are expressed as mean±SD or percentages. Metrics were compared using students paired two tailed t-test. Results: 8 S-1013 AGA Abstracts normal subjects and 239 patients (149 classified in supine position as no abnormalities, 2 achalasia type I, 4 achalasia type II, 2 achalasia type III, 23 EGJ outflow obstruction, 4 diffuse esophageal spasm, 8 jackhammer esophagus, 4 absent contractility, 38 ineffective motility, 4 fragmented motility) were included (Table 1). Change in HREM metrics: DCI decreased in both normal subjects (936±398 mmHg x cm x sec, p<0.001) and patients (539±1005 mmHg x cm x sec, p=0.03). IRP decreased in both normal subjects (6.6±6.5 mmHg, p=0.02) and patients (4.8±5.7 mmHg, p<0.001). UES pressure decreased in both normal subjects (32.6±21.6 mmHg, p=0.007) and patients (26.1±41.2 mmHg, p<0.001). LES pressure also decreased in both normal subjects (11.2±16.7 mmHg, p=0.10) and patients (7.4±21.7 mmHg, p<0.001). Change in CC diagnosis: 100 of 239 patients (42%) had a change in CC diagnosis in the upright position (Table 2). 51 of 149 patients (34%) with no abnormalities in the supine position were found to have esophageal dysmotility in the upright position. 49 of 90 patients (54%) with esophageal dysmotility in the supine position had a change in CC diagnosis in the upright position, including 19 patients (21%) who were found to have no abnormalities. Conclusions: Upright positioning decreases DCI, IRP, UES and LES pressures as compared to conventional supine positioning in both normal subjects and patients. Importantly, upright positioning can alter esophageal motility patterns; in this study, 42% had a different diagnosis by CC. Upright positioning supplements the supine swallows to help further characterize esophageal disorders. Tu1275 HEMATOLOGICAL INDICES IN ACHALASIA PATIENTS AND THEIR CLINICAL SIGNIFICANCE Fidel López-Verdugo, Janette Furuzawa-Carballeda, Fernanda Romero-Hernández, Enrique Coss-Adame, Miguel A. Valdovinos, Sofia Narvaez-Chavez, Jose Peralta-Figueroa, Hector Olvera-Prado, Gonzalo Torres-Villalobos Background:: Complete blood count (CBC)-derived parameters such as neutrophil-to-lym- phocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte (ELR) ratio, and platelet-to-lymphocyte ratio (PLR) have recently shown to be sensitive markers of occult inflammation. They have been investigated as disease activity markers for systemic lupus erythematosus, rheumatoid arthritis, psoriasis, esophageal cancer, thyroid disorders, and other inflammatory disorders. Etiology of achalasia has been described to be autoimmune. Aim: We assessed NLR, PLR, MLR, and ELR as peripheral markers of inflammation in patients with achalasia compared with healthy donors. Methods: This was an exploratory, observational, and cross-sectional study. Patients with achalasia and healthy blood donor volunteers were recruited for the study. Demographic, clinical and laboratory information was collected and analyzed. NLR, MLR, ELR and PLR were calculated. Correlation between hematologic indices and clinical questionnaires scores, as well as HRM parameters were assessed. Hematologic parameters associated with the different achalasia subtypes were evaluated by logistic regression analysis. Results: A total of 603 subjects were included in this study. Patients with achalasia (n=103) had a mean age of 42.6±15.0 compared to 36.3±11.7 for healthy donors (n=500). Both groups had 63% of female participants. CBC results were within normal limits in both groups. Hemoglobin, leukocyte, lymphocyte, AGA Abstracts