for BC (P 5 0.005 vs 3 mg BRG BID), and 60.0% for LBRG (P 5 0.06 vs 3 mg BRG BID). Symptomatic remission was similar between groups, as was change in EREFS and change in eo- sinophil counts. Non-responders to HBRG had mean decrease in eosinophil count of only 0.3/hpf (vs 53.2/hpf for responders, P , 0.003) and mean change in EREFS of 11.6 (vs 21.1 for responders, P , 0.001). 62.5% of non-responders to HBRG actually had increase in eosinophil count after steroids. Response rate to HBRG at , 5 eos/hpf was 77.8% overall and 94.6% in those achieving remission. CONCLUSION: A higher remission rate achieved with a more viscous steroid preparation com- pared to other formulations suggests the importance of both dose and esophageal delivery in treatment of EoE. Further, with adequate mucosal delivery and dosing of topical steroids, steroid refractory EoE appears to be uncommon. On the other hand, these results suggest the existence of a small truly steroid refractory group of EoE patients with negligible histologic, symptomatic and endoscopic response to high dose steroids that warrant further investigation. 378 Resting Upper Esophageal Sphincter Pressure Is Elevated in Proton Pump Inhibitor-Refractory Chronic Cough Patients and May Be a Marker for Laryngeal Hypersensitivity John Bloch, MD, MPH 1 , Salih Samo, MD 1 , Anand Jain, MD 2 . 1 Emory University School of Medicine, Atlanta, GA; 2 Emory University, Atlanta, GA. INTRODUCTION: Chronic cough is difficult to treat when unresponsive to proton-pump inhibitor (PPI) and sinus therapy. In this setting it is presumed to be neurogenic in etiology. Despite the role of the upper esophageal sphincter (UES) as a barrier to laryngopharyngeal reflux disease, it has not been well characterized in chronic cough patients. We aim to assess UES tonicity in patients with PPI- refractory chronic cough and otherwise intact esophageal motor function. METHODS: Patients with a Chicago Classification diagnosis of normal esophageal motility on high- resolution esophageal manometry (HRM) on studies performed for the indication of chronic cough were retrospectively studied. All studies were performed at a GI motility lab at a tertiary care center from January 2013 to August 2018. Patients with prior cervical spinal surgery, foregut surgery, gastroparesis, severe pulmonary disease or manometric hiatal hernia were excluded. All HRM were performed with a solid-state assembly with a 4.2 mm outer diameter catheter. Upper esophageal resting pressure and residual pressure (mmHg) were recorded from HRM studies and compared to a control group of patients with normal esophageal motility on studies performed for an indication of non-cardiac chest pain. Available pH-metry tests in chronic cough patients were also reviewed for acid exposure time. RESULTS: Fourteen patients with chronic cough (mean age 63 6 25, 71% female) and twenty patients with non-cardiac chest pain (mean age 55 6 14, 60% female) were included. Median resting UES pressure (mmHg) was higher in the chronic cough group (80) vs the chest pain group (50.8) with a p value of 0.004 (Figure 1). There was no difference in residual UES pressure (3.5 in chronic cough vs 3.15 in chest pain). A total of 12 pH studies were performed in chronic cough patients; 9 of these were on PPI. Median distal acid exposure time % was 1.35 [IQR 0.5-6]. CONCLUSION: UES hypertonicity found in PPI-refractory chronic cough patients may be a marker of laryngeal hypersensitivity. A second possibility is that primary UES dysfunction is the cause of cough in this subgroup. 379 Safety and Efficacy of Peroral Endoscopic Myotomy (POEM) in Patients ‡ 65 Years at a Single Academic Tertiary Care Center Jagpal S. Klair, MD 1 , Yazan Hasan, MBBS 2 , Maen Masadeh, MD 3 , Henning Gerke, MD 4 , Arvind Murali, MD 4 , Kalpaj Parekh, MD 4 , John Keech, MD 4 , Peter Nau, MD 4 , Rami El Abiad, MD 4 . 1 Digestive Diseases Institute, Virginia Mason Clinic, Seattle, WA; 2 University of Iowa Hospitals & Clinics, North Liberty, IA; 3 University of California San Francisco Medical Center, San Francisco, CA; 4 University of Iowa Hospitals & Clinics, Iowa City, IA. INTRODUCTION: Peroral endoscopic myotomy (POEM) has been proven to be effective for treating esophageal dysmotility disorders. Herein is a report of the safety and efficacy of POEM in patients aged $65 years at an academic US tertiary care center. METHODS: Medical charts of all patients aged $65 years that underwent POEM between De- cember 2014 and October 2018 were retrospectively reviewed. Demographic data, clinical data and treatment outcomes were obtained. POEMs were performed by multidisciplinary teams each in- cluding 1 of 2 endoscopists (HG, RE) and 1 of 3 surgeons (KP, PN, JK). Clinical success was defined as Eckardt score # 3 and improvement of symptoms. RESULTS: During the study period, 62 patients were included. The mean age of patients was 72.3 6 5.7 years (range 65-89 years; 42% women). Mean BMI was 29.8 kg/m 2 . Indications for POEM included Achalasia 88.7%, diffuse esophageal spasm (DES) 6.5%, Jackhammer esophagus 3.2% and esophagogastric junction outflow obstruction (EGJOO) 1.6%. There were 2 intraoperative complications documented (pneumothorax and anaphylaxis to medication). Mean pretreatment IRP was 24.1. Pretreatment Eckardt score was 6.98 6 2.2 compared with posttreatment Eckardt score of 1.25 6 2(P , 0.05). Clinical success (Eckardt score #3) was achieved in 88.7% of patients. Mean myotomy length 13.8 cm (posterior ori- entation of myotomy 75.8%). Median hospitalization duration was 1.9 days. Postoperative complications included 1 patient with esophageal leak on postoperative esophagram, 1 patient with esophageal stricture, and 1 patient with both stricture and leak. No deaths occurred. Six patients with persistent symptoms post POEM required through-the-scope dilation to achieve improvement in symptoms. CONCLUSION: POEM can be safely carried out in symptomatic elderly patients $ with esophageal dysmotility disorders. An excellent clinical response (88.7%) was noted in this patient cohort. 380 High Resolution Manometry Findings in Patients With Absent Contractility Xiaowen Fan, MD 1 , Il J. Paik, MD 2 , Xiaocen Zhang, MD 1 , Gassan Kassim, MD 1 , Melissa Hershman, MD 3 , Elijah Verheyen, MD 1 , Jean Abed, MD 1 , Michael S. Smith, MD, MBA 4 . 1 Mount Sinai St. Luke’s and Mount Sinai Roosevelt, New York, NY; 2 University of Miami Health System, Miami, FL; 3 Mount Sinai Beth Israel Medical Center, New York, NY; 4 Mount Sinai West and Mount Sinai St. Luke’s Hospitals, New York, NY. INTRODUCTION: High resolution manometry (HRM) is a widely utilized diagnostic tool for identifying esophageal motility disorders. The Chicago Classification V3.0 (CC3) applies a hierar- chical stepwise approach to the analysis of HRM parameters, allowing for characterization and diagnosis of different disorders. While upper esophageal sphincter (UES) parameters are not utilized in CC3, studies have shown that these values could potentially help in differentiating between different disorders. The aim of this study was to evaluate for trends in esophageal sphincter parameters in patients with absent contractility (AC). METHODS: Reports for esophageal HRM performed at a single referral-based motility center between 2013 and 2018 were retrospectively analyzed. We selected patients diagnosed with either AC (study group) or no CC3 abnormality (control group), and divided them by age group. The primary outcome included differences in parameters related to both the lower esophageal sphincter (LES) and UES. Multivariate regression analysis was used to adjust for age group and sex. RESULTS: A total of 455 patients were included in the study (Figure 1), 52 with AC (mean age 51.4, 50.0% female) and 403 without CC3 abnormality (mean age 52.8, 69.5% female). The primary indication for HRM was more likely to be dysphagia in AC patients (73.1% vs 30.5%, P , 0.01), whereas GERD was more likely to be reported in controls (67.2% vs 25.0%, P , 0.01). AC diagnosis was associated with a lower LES mean basal pressure (14.9 vs 27.0 mmHg, P , 0.01) and LES mean residual pressure (5.9 vs 7.9 mmHg, P , 0.01). However, UES mean residual pressure (2.1 vs 0.1 mmHg, P 5 0.02) and UES mean relaxation time to nadir (296.4 vs 228.5 ms, P 5 0.04) were significantly higher compared to control. No significant difference in UES mean basal pressure was identified between the study group and control. CONCLUSION: AC affects both the LES and UES, causing decreased LES basal and residual pressures, along with increased UES residual pressures and UES relaxation time to nadir. Our data suggest that AC affects smooth muscle in both the esophageal body and LES, where it causes decreased LES tone. The increased UES residual pressures and relaxation time to nadir might be compensatory adaptation to poor esophageal bolus clearance to prevent esophago-pharyngeal reflux. [377] [377] [378] Figure 1. Resting upper esophageal sphincter pressure in PPI-refractory chronic cough patients vs. controls (Chest pain). © 2019 by The American College of Gastroenterology The American Journal of GASTROENTEROLOGY Abstracts S221 Copyright © 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.