Purpose: Achalasia occurs at a rate of approximately 1 to 2 per 200,000 population per year. The disease affects both sexes in equal numbers and can occur at any age. Onset is usually in the third to fifth decades, and fewer than 5% of patients have symptoms before adolescence. The manometric and clinical features in older patients with achalasia have not been char- acterized at presentation, but rather after chronic disease. 1. To compare the manometric patterns of esophageal peristalsis in achalasia in three different age groups ( 40 yrs, 40 – 65 yrs and  65 yrs). 2. To compare the LES pressure and residual pressure in the different age groups. Methods: 100 patients with documented achalasia by esophageal manom- etry were included in the study at their presentation. None of the patients received any treatment for achalasia. There were 21  40 yrs, 41 between 40 – 65 yrs and 38 patients age  65 yrs. There were 45 males and the rest females. Results: The LES pressure (mean  SEM) in the three age groups ( 40 yrs, 40 – 65 yrs and age  65 yrs) was 37.59  5.23 mmHg, 43.98  3.49 mmHg and 64.9  5.48 mmHg, respectively (P  0.05 between patients age  65 yrs and the other two age groups). The residual LES pressure in the three age groups was 12.19  1.98 mmHg 12.73  1.55 mmHg and 16.44  1.75 mmHg, respectively (P  0.05). The amplitude in the distal probe (3cm from LES) in the three age groups was 30.02  5.55 mmHg, 38.2  5.96 mmHg and 44.83  6.37 mmHg, respectively (P  0.05). The amplitude in the proximal probe (13 cm from LES) in the three age groups was 77.88  8.97 mmHg, 90.05  5.98 mmHg and 91.43  6.1 mmHg, respectively (P  0.05). Conclusions: 1. The LES pressure and residual pressure are higher in older patients at presentation of symptoms. 2. The amplitude of esophageal contraction, both proximal and distal shows a trend to being higher rather than lower in older patients. Manometric findings in achalasia suggest a more hypertensive pattern in older patients at clinical presentation. 44 AN EVIDENCE-BASED APPROACH PROVIDES A QUANTITATIVE ASSESSMENT OF THE EFFICACY OF ESOMEPRAZOLE FOR HEALING OF EROSIVE ESOPHAGITIS BASED ON DISEASE SEVERITY David A. Johnson, M.D., FACG*, Paul E. Hoyle, Ph.D., Barry M. Traxler, B.S., Douglas Levine, M.D., FACG. Eastern Virginia School of Medicine, Norfolk, VA and AstraZeneca LP, Wilmington, DE. Purpose: Esomeprazole (Eso) is the only PPI proven in clinical trials to be more effective than lansoprazole (Lanso) and omeprazole (Ome) for heal- ing and symptom resolution in patients with reflux-associated erosive esophagitis (EE). Number needed to treat (NNT) provides a real-world estimate of the number of patients who need to be treated with a drug to avoid an adverse outcome on alternate therapy. This quantitative analysis focused on treatment responses to PPIs according to disease severity. Methods: Efficacy data for once-daily Eso 40 mg compared with Ome 20 mg and Lanso 30 mg for the treatment of EE were identified in 4 clinical trials, 3 with Ome and 1 with Lanso as the comparator. At baseline, EE was graded A–D using the Los Angeles classification. The therapeutic gain (absolute risk reduction [ARR]) and NNT (the reciprocal of the ARR) for healing of EE at Week 8 for all patients and for patients with severe disease (LA grade C or D) were calculated. Results: Across all grades of esophagitis, the therapeutic gain achieved with Eso was 9.5%, 7.2% and 2.4% versus Ome, and 3.8% versus Lanso. The NNT with Eso for all patients and for those with severe disease is shown (figure). The NNT with Eso for severe disease ranged between 5 and 10 relative to Ome. The NNT with Eso for severe disease was 8 relative to Lanso, indicating that for every 8 patients treated with Eso, 1 treatment failure with Lanso may be prevented. Conclusions: Treatment with Eso provided therapeutic gain regardless of the baseline severity of EE compared with Lanso and Ome. The NNT with Eso for patients with severe disease was lower relative to that for patients with all grades of EE, an indication of increased efficacy with Eso that may be related to improved acid suppression. Because the severity of clinical symptoms is not predictive of disease severity, treatment with the most effective agent appears to be a rational therapeutic decision as supported in this evidence-based approach. 45 A DECADE (1991–2000) OF INCREASING INCIDENCE OF ENDOSCOPIC AND HISTOLOGIC BARRETT’S ESOPHAGUS (BE) AT A SINGLE ACADEMIC MEDICAL CENTER Shayan Irani, M.D., Henry Parkman, M.D., Benjamin Krevsky, M.D., Rebecca Thomas, M.D., Robert Fisher*. Temple University Hospital, Philadelphia, PA. Purpose: BE is being diagnosed increasingly by endoscopists. The aim of this study was to determine whether increased EGD reporting of BE can be confirmed histologically, and whether it represents a true increasing inci- dence of BE or is the result of increasing number of EGDs. Methods: This was a retrospective study of patients who underwent EGDs from Jan 1991 through Dec 2000, and were diagnosed with suspected BE on endoscopy. EGD reports were accessed by a computerized endoscopy database of 18,163 EGDs. Reports containing terms “BE”, “salmon colored mucosa”, and “irregular squamo-columnar mucosa” were identified by year. Follow-up EGDs for BE were excluded. The annual incidence of new cases of suspected BE on EGD was obtained. All biopsy results were then reviewed to confirm the diagnosis of BE (specialized intestinal metaplasia). The incidences of suspected BE on EGD and confirmed BE on histology, were normalized using the total number of EGDs per year as the denom- inator. Results: After normalizing for the number of EGDs per year, the rates of suspected BE on EGD increased from 3.22/100 EGDs to 8.28/100 EGDs (257%; p 0.01), and on histology from 0.67/100 EGDs to 2.76/100 EGDs (412%; p 0.01) from 1991 to 2000. The percentage of patients with EGD diagnoses of BE, confirmed as specialized intestinal metaplasia by histol- ogy for the decade was 24.7% (252/1,020). An additional, 22.2% of EGD suspected to have BE had fundic and cardiac like columnar metaplasia. Thus, 46.9% of EGD suspected to have BE were confirmed as having a columnar-lined esophageal mucosa. Incidence of Suspected BE on EGD and Confirmed BE on Histology from 1991 to 2000 YEAR EGD- Total suspected BE HISTOLOGY- intestinal metaplasia HISTOLOGY- non-intestinal metaplasia Total No. of EGD Normalized EGD incidence of BE per year (# per 100 EGDs) Normalized Histologic incidence of BE per year (# per 100 EGDs) 1991 48 10 14 1,491 3.22 0.67 1994 58 17 19 1,926 3.01 0.88 1997 115 22 25 1,728 6.69 1.28 2000 180 60 29 2,173 8.28 2.76 S16 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003