AGA Abstracts Su1891 Evaluation of High-Resolution Esophageal Manometry, Gastrointestinal Symptoms, and Pulmonary Disease in Scleroderma Benjamin Basseri, Elizabeth Volkmann, Jeffrey L. Conklin, Nabeel Borazan, Christopher Chang, Daniel E. Furst, Mark Pimentel The most common visceral manifestations of scleroderma or systemic sclerosis (SSc) involve the esophagus—most commonly gastroesophageal reflux (GERD) and dysphagia —and lungs—commonly interstitial lung disease—and contribute heavily to morbidity and mortal- ity in this disease. In this study, we evaluate esophageal function in patients with SSc and assess for association between foregut dysfunction and pulmonary disease in this population. Methods: This is a two center retrospective analysis evaluating demographic, symptom, radiographic, pulmonary function, high-resolution esophageal manometry (HRM) and lactu- lose hydrogen breath test (LHBT) data in subjects with SSc. Pulmonary and gastrointestinal studies were compared. The study was approved by each site's respective Institutional Review Board. Results: Twenty-two subjects (21 women) met criteria for SSc with sufficient data available for study inclusion. Mean age (±standard error of mean) was 56.3±3.4 years, body mass index (BMI) 23.1±1.2 (kg/m2), and disease duration 60.1±17.8 months. Seventeen of 18 patients (94.4%) with medication history available were using proton pump inhibitors (PPIs). Ten patients demonstrated abnormal resting upper esophageal sphincter (UES) pres- sure (P) (7 (31.8%) low; 3 (13.6%) high) and 10 (45.5%) also demonstrated prolonged UES relaxation time-to-nadir. Low resting UESP was associated with a trend toward more severe reflux and bloating symptoms (p=0.16). Mean distal contractile integral (DCI) was 1140.1±439.6. Mean peristaltic, simultaneous and failed contractions were 21.4±7.1%, 8.5±2.9%, and 66.0±9.1%, respectively. Those with ineffective esophageal motility (IEM; ≥30% failed swallows) had significantly more severe reflux symptoms (p=0.03) and lower BMI (5.2 kg/m2; p=0.06). Resting LESP (normal 13-43 mmHg) was hypotensive and hyper- tensive in 7 (31.8%) and 2 (9.1%) patients, respectively. Hypotensive LES was associated with a trend toward longer duration of onset of non-Raynaud's symptoms (p=0.22). Hiatal hernia was uncommon (n=1; 4.5%). In those with pH studies performed, 5 of 6 (83.3%) and 1 of 2 patients had increased distal and proximal acid exposure, respectively. LHBT was positive for hydrogen and methane in 6 (54.5%) and 4 (36.3%) of 11 patients, respec- tively. Seven of 12 (58.3%) had delayed gastric emptying. Seven of 15 patients (46.7%) had diffusing capacity (DLCO) ,80% predicted and ground-glass opacities were seen in 4 of 14 (28.6%) subjects on computed tomography. Conclusions: GERD and PPI use are extremely common in SSc. Hypotensive UES and LES are each present in 1 in 3 patients with SSc and may be associated with foregut symptom severity and disease duration. IEM in SSc is associated with more severe reflux symptoms and lower BMI. Larger studies are necessary to further investigate associations with foregut dysmotility and pulmonary disease in SSc. Su1892 May We Use Sydney Swallow Questionnaire in Esophageal Dysphagia? Sabine Roman, Frank Zerbib, Sophie Marjoux, Amandine Mourthe, Francois Mion Background: Clinical symptoms of oropharyngeal dysphagia are different from those of esophageal dysphagia. Sydney swallow questionnaire (1) has been developed to evaluate oropharyngeal dysphagia. Our aim was to evaluate this questionnaire to predict the occur- rence of an esophageal motility disorder in patients with dysphagia whatever its location. Patients and methods: Eighty-four patients with dysphagia (33 men, mean age 55 years, range 18 -88) were prospectively included from March 2011 to November 2012. Upper endoscopy failed to find an etiology to dysphagia. These patients underwent esophageal high resolution manometry (HRM) within a prospective randomized trial. Esophageal motility disorders were diagnosed according to the Chicago classification. According to the subjective location by the patient, dysphagia was classified as upper or lower dysphagia. Sydney questionnaire was administrated to patients: this questionnaire included 15 questions on dysphagia characteristics and 2 questions on quality of life. The maximal score was 1700 and was lower than 200 in healthy controls in the validation study (1). Scores were expressed as mean ± SD and compared using Anova test according to the dysphagia location and to the motility disorders diagnosed with HRM. Results: Patients considered dysphagia as upper in 35% and as lower in 65 %. Esophageal motility disorders were equally distributed between the 2 groups while pharyngeal and upper esophageal sphincter (UES) abnormalities were encountered only in patients who complained about upper dysphagia (Table). Sydney scores were similar in patients with upper and lower dysphagia (576 ± 350vs 561 ± 342 respectively, p=0.85). This score was significantly higher in patients with achalasia or esophago-gastric junction outflow obstruction (EGJOO) and pharyngeal/UES disorders than in those without motility disorders. Quality of life was also significantly impaired in patients with achalasia. None of the patients with a score , 200 had achalasia or pharyngeal/UES abnormalities depicted on manometry. Conclusion Subjective location of dysphagia was not predictive of any esophageal motility disorders. Sydney score initially developed for oropharyngeal dyspha- gia was also elevated in esophageal dysphagia. Patients with impaired lower or upper sphincter relaxation had highest scores. Sydney questionnaire might be used for achalasia follow-up. Reference: (1) Wallace et al. Gastroenterology 2000 *p,0.05 vs no motility disorder S-502 AGA Abstracts Su1893 Problems With Swallowing Pills Commonly Relates to Properties Like Size Jorge Go, Jeremy Fields, Satish S. Rao, Konrad S. Schulze Introduction: A commercial phone survey in 1980's elicited pill dysphagia in up to 40% of the general population. Still, most gastroenterologists ignore pill dysphagia in the absence of food dysphagia. Aims: (1) to identify any problems Americans experience with their daily medications (prescription drugs, supplements etc); (2) to determine which material properties (capsule versus tablet, size, shape, surface texture) cause the problems; and (3) to identify which compounds Americans would prefer. Methods: GI fellows conducted structured interviews with adults visiting or working in UIHC; subjects rated and compared commonly- used tablets and capsules for swallowing effort. Results: There were 99 subjects (65 female, median age 41 years [range 23-77]). 83 subjects took solid medications daily (mean of 4 drugs/day; 27 subjects . 5 tablets/drugs, 10 subjects .10 drugs, 5 subjects . 15 drugs). Problems included: 1 pill esophagitis, 7 stopped medication due to swallowing problems, 22 had to swallow repeatedly, 24 had to make undue effort, 50 had to take extra water. 30 identified at least one material drug problem: size - 20 too large, 5 too small; 12 faulted surface texture; 3 sharp/odd shape and 3 taste/smell. 1 gram calcium tablets ( .15 mm long) scored 3.6 (1-4 scale) for swallowing effort (4=hard or impossible to swallow). Most would rather take 3 or more medium sized tablets instead of the extra large tablet. Very small pills (,3mm) such as diuretics, thyroid replacement and contraceptives also commonly caused problems. 50 prefered capsules vs. 49 tablets of same size; 49 prefered round vs. oval tablets same size; 80 prefered coated over chewable baby aspirin. Conclusion: Many Americans experience problems swallowing solid medications in current use, and this may seriously affect their treatment outcome and compliance. Most problems would be avoided by using solid compounds of proper size, shape and surface texture. Su1894 What Can We Learn From Performing High-Resolution Manometry/Impedance in Patients With Achalasia? Jeffrey R. Lewis, Ari Grinspan, Barry Jaffin BACKGROUND: Achalasia is an esophageal motility disorder characterized by absent peristal- sis and failure of lower esophageal sphincter relaxation (LESR). Recently, high-resolution manometry (HRM) has been used to characterize three distinct sub-types of achalasia. Each sub-type displays a unique swallow-induced pressure pattern within the esophagus. Evidence suggests that sub-typing achalasia based on these patterns can predict responses to medical and surgical therapies for this condition. However, there is a paucity of research examining manometric variables beyond LES pressure and contraction amplitudes that help distinguish the three sub-types of achalasia. METHODS: High resolution manometry with impedance (HRMi) studies performed on 22 consecutive achalasia patients by one physician (BJ) during a 15-month period ending in 11/2012 were included in this study. Achalasia was defined manometrically when 100% of swallows contained simultaneous contractions. Variables such as basal LES pressure, residual LES pressure, wave amplitude, intra-bolus pressure [(IBP) maximum and at LESR], and distal contractile index (DCI) were recorded. Our primary aim was to identify whether LES pressure, IBP, and DCI were associated with achalasia sub- types. Our secondary aim was to identify relationships between manometric variables. Pearson correlation coefficient analysis was performed using SPSS to accomplish the secondary aim. RESULTS: 200 consecutive HRMi studies were reviewed in total. Of these, 22 consecutive studies with a diagnosis of achalasia were included in this study. The breakdown of achalasia sub-types was as follows: 10/22 (46%) type I, 8/22 (36%) type II, and 4/22 (18%) type III. Regarding the primary aim, when the variables of mean basal LES pressure, IBP, and DCI were compared between achalasia types, type I achalasia appeared to be associated with lower mean basal LES pressure, IBP (maximum and at LESR), and DCI (see table 1 below). In the Pearson correlation analysis performed, several positive relationships were identified (Pearson correlation in parentheses). Basal LES pressure was related to residual LES pressure (0.936), mean DCI (0.675), and IBP at LESR (0.609). Residual LES pressure was related to mean DCI (0.724) and IBP at LESR (0.712). Finally, achalasia type was related to wave amplitude (0.802) and mean DCI (0.570). CONCLUSION: Among patients at a tertiary- care medical center undergoing HRMi, type I achalasia appeared to be associated with lower basal LES, IBP, and DCI. These findings may help distinguish achalasia sub-types. However, it is unclear whether these manometric differences explain response to medical and surgical therapies for achalasia. Additional investigation is warranted. Manometric Variables and Achalasia Sub-Types Su1895 Achalasia Subtypes by Chicago Classification: Clinical Characteristics and Therapeutic Response of Balloon Dilatation Moo In Park, Seun Ja Park, Won Moon, Hyung Hun Kim, Eun Ju Cho, Gyoo Sik Jung Introduction: High-resolution manometry (HRM) offers several advantages to diagnosis of achalasia and prediction of the therapeutic response as classifying into 3 subtypes by Chicago classification. The aims of this study is to compare the clinical characteristics, manometric variables and treatment outcomes within the subtypes of achalasia based on the HRM findings. This is the first study in the Korean population. Method: Patients diagnosed with