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Background Upper esophageal sphincter (UES) function may be evaluated manometrically using a solid-state high-resolution manometry (HRM) system, which allows for the measurement of manometric parameters specific to the UES. While many of these parameters have yet to be validated for use in clinical practice, there is some suggestion that there may be an association between esophageal motility and UES function. Aims We aimed to identify the relationship between UES manometric variables and high-resolution esophageal manometry (HREM) diagnoses. Methods A retrospective analysis of HREM studies was performed between 2019 and 2021. Extraction of esophageal and UES manometric variables were performed. UES manometric values of interest included: mean basal pressure (mmHg), mean residual pressure (mmHg), relaxation time-to-nadir (ms), relaxation duration (ms), and recovery time (ms). Relationships between manometric diagnosis (Chicago Classification version 3) and UES manometric variables were explored. All values are expressed a medians and group means were compared with the non-parametric Mann-Whitney U test. Results 2119 symptomatic patients underwent HREM over the study period. Manometric diagnoses were achalasia (72 patients), esophagogastric junction outflow obstruction (286), absent contractility (108), distal esophageal spasm (53), jackhammer esophagus (32), and ineffective esophageal motility (694). 886 patients had no specific motility disorder; 643 of whom had ≤ 20% ineffective swallows and were considered symptomatic controls. Patients with achalasia had significantly higher mean basal pressures (63.2 vs. 54.4, p = .001), mean residual pressure (3.8 vs. -1.9, p < .001), relaxation-time-to-nadir (182.0 vs. 142.0, p = .005), relaxation duration (820.5 vs. 708.0, p < .001) and recovery time (623.0 vs. 562, p < .001) compared to control patients. Among patients with achalasia, the presence of panesophageal pressurization correlated weakly with recovery time (R2 .3, p = .03). Patients with ineffective esophageal motility had significantly higher mean basal pressures (61.7 vs. 54.0, p < .001). Among all patients, patients with incomplete bolus clearance (≥ 30%) had significantly higher UES mean basal pressure (58.9 vs. 54.6, p = .004), mean residual pressure (-.62 vs. -2, p < .001), relaxation duration (724.0 vs. 707.0, p = .014) and recovery time (580 vs. 558.0, p < .001). Conclusions Patients with achalasia may have higher basal and residual UES pressures, and slower relaxation compared to patients with normal esophageal motility. This may reflect dynamic changes of the UES in response to obstruction at the esophagogastric junction. Elevated UES pressures are also seen in patients with ineffective esophageal motility, potentially reflecting a response to poor bolus clearance. More work needs to be done to validate these parameters in clinical practice. Funding Agencies None

A new apparatus, named Bang-Bang (BB), which can facilitate the in situ nylon bag measurement of ruminal degradation in beef cattle, is described. The BB is an apparatus specially designed as a replacement of the traditional steel chain or flexible plastic tubes for binding the bags used in the in situ nylon bag (ISNB) method. The BB apparatus consists of cylindrical pedestals, sealing clips, nylon string, and nylon bags. A series of in situ rumen incubations using 3 ruminally cannulated beef steers were conducted to compare the BB with the ISNB method by measuring rumen DM degradation kinetics of 12 different feedstuffs commonly offered to beef cattle in China. Greater ( < 0.01) DM disappearance and less ( < 0.01) relative SD (%) were observed with the BB than with the ISNB method. In addition, effective degradability of DM was highly correlated between the 2 methods (ISNB = (1.01 ± 0.04 × BB) - 4.03 ± 2.12; = 0.99, < 0.001, = 12). These results indicate that the BB apparatus can be effectively used to determine the rumen degradation properties of feedstuffs with advantages over the traditional ISNB technique.

BACKGROUND: Dysphagia and non-cardiac chest pain are common referrals for esophageal motility testing. Hypertensive esophageal peristalsis, previously classified as “nutcracker esophagus,” has been re-labelled as “jackhammer esophagus” by the Chicago Classification of esophageal motility disorders (CC v3.0). Although the pathophysiology of jackhammer esophagus (JE) has yet to be elucidated, gastroesophageal acid reflux (GERD) has been implicated as a possible causative factor, based on the higher than expected incidence of GERD on patients with JE that has been seen in previous studies (43 - 47%). AIMS: The aim of this present study is to determine if GERD is associated with JE when compared to symptomatic controls with normal HRM. METHODS: Consecutive symptomatic patients who were referred for esophageal high-resolution manometry (HRM) studies in Calgary, AB from Nov 2013 to Sept 2018 were retrospectively analyzed. Patients with a manometric diagnosis of Jackhammer esophagus by CC v3.0 (≥ 2 hypercontractile swallows with distal contractile integral [DCI] > 8000 mmHg-s-cm) who also underwent ambulatory pH studies were compared to patients with normal HRM (controls). Groups were compared with Pearson’s chi-square testing and ANOVA as appropriate. This study was IRB approved. RESULTS: 20 JE patients and 82 controls who underwent both HRM and ambulatory pH testing were identified. Age and gender breakdown were similar between both groups (see Table 1). The most common presenting complaint in the JE group was dysphagia (35.0%) and in controls was heartburn (26.8%). Similar numbers of both groups were on PPI (50.0% JE, 51.2% controls). 3 (25.0%) JE patients and 14 (17.1%) controls had evidence of abnormal acid exposure on 24h ambulatory pH study (defined as DeMeester score > 14.7); this difference was not significant (p = 0.56). When abnormal acid exposure was defined as acid exposure time (AET) > 4.2%, there was no significant difference seen between both groups (p = 0.50). There were no significant differences seen between other parameters of the DeMeester score (see Table 1). CONCLUSIONS: Abnormal acid exposure on ambulatory pH study does not appear to be associated with JE, when compared to patients with normal HRM. This finding suggests that abnormal esophageal acid exposure is unlikely to be a causative factor for the peristaltic abnormalities seen in Jackhammer esophagus. FUNDING AGENCIES: None

BACKGROUND: Functional diseases, like IBS, lead to considerably poor quality of life (QoL). It is not known if current management strategies for IBS-constipation (IBS-C) provide changes in patient-reported QoL. AIMS: To assess the influence of management practices on QoL in patients with IBS-C METHODS: Patients with confirmed diagnosis of IBS-C were recruited for this study from Foothills Medical Centre and South Health Campus over a period of 2 years. Recruitment was followed by an invitation to complete a validated IBS QoL questionnaire, symptoms questionnaire and medications questionnaire on initiation and at 60 days. RESULTS: Eleven patients (ten females and one male), with an average age of 48, were recruited. There was a significant improvement in the total QoL scores at 60 days compared to baseline (pairwise t-test, p-value 14-point) in their scores. The 34-part QoL is used to calculate 9 subscale scores and overall QoL scores. Figure 1 shows a graph of QoL scores comparing baseline and 60 days QoL scores. Tables 1 and 2 shows statistical analyses of the subscales at baseline and 60 days. A Pearson’s r analysis between change in symptoms and change in QoL scores revealed a strong positive correlation (r = 0.74) for the change in severity of IBS symptoms to change in QoL and moderate positive correlation (r=0.65) for a reduction in pain to change in QoL (p