S947 The Neglected Upper Esophageal Sphincter (UES): Towards Understanding Its Role in Supraesophageal Symptoms (SES)

Introduction: Supraesophageal symptoms (SES) are common source of gastroenterology (GI) referrals, and a high-resolution esophageal manometry (HREM) is commonly done as part of the workup. The focus of the HREM is mainly to evaluate the esophageal body motor function and the lower esophageal sphincter (LES). However, the upper esophageal sphincter (UES) measurements, even though universally reported, are usually neglected when determining clinical management. Our hypothesis was that a hypotensive UES may render the supraesophageal area more to any retrograde reflux material and thus contribute to SES. We sought to evaluate the UES pressures in the presence of supraesophageal symptoms. Methods: We reviewed patients undergoing HREM at a motility unit of an academic medical center in 2025. We searched for the following supraesophageal symptoms (alone or in combination with others): cough, globus, throat pain, laryngopharyngeal reflux, throat clearing, orophagryngeal dysphagia, aspiration) and were catalogued as harboring SES. We then look into the HREM report, and we considered a hypotensive UES pressure <34.0 mmHg (normal: 34-104 mmHg). The UES relaxation (normal <12.0) was also recorded. Proportional data was compared using the Fisher’s exact test and means using the Mann-Wittney test. A P value < 0.05 was considered statistically significant. Results: Of the 101 patients undergoing HREM, 62 were women and the mean age was 63.4 years. Forty-eight of these patients had a hypotensive UES with a mean pressure of 20.4 mmHg that was significantly lower than the remaining 53 patients who had a mean UES pressure of 52.3 mmHg (P < 0.001). There were 43 patients with at least 1 SES being cough the most common (60.5%), followed by globus (18.6%) and in these, the mean UES pressure was significantly lower than in those without a SES (26 mmHg vs 37 mmHg; P = 0.02). The presence of SES and hypotensive UES was significantly more common (60.5%) than those with SES and non-hypotensive UES (39.5%) (P = 0.02). The UES relaxation was similar in both groups. Conclusion: Our data shows that patients with hypotensive UES on HREM are more frequently reporting SES, and hypotensive UES may likely be at least 1 pathogenetic factor contributing to these symptoms. Assessment of UES pressure on HREM may provide valuable insight into pathophysiology of supraesophageal symptoms and help inform clinical management.