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Introduction Non-obstructive dysphagia occurs in 30–50% of patients with gastroesophageal reflux disease (GORD) (Samaan et al., World J of Gastroenterol 2020). Reflux-induced oesophageal dysmotility resulting from chronic acid exposure is thought to be a key underlying mechanism (Cohen et al., Dig.Dis.Sci. 2019). This study aims to explore this association by evaluating objective physiological measurements in patients with dysphagia, GORD, and impaired oesophageal motility.Methods A retrospective review of clinical records for patients who underwent oesophageal physiology studies at St George’s Hospital between 2021 and 2025 was performed. Patients with outflow obstruction/achalasia, hypercontractile/spastic motility and previous upper GI surgery were excluded. The hospital odynophagia dysphagia questionnaire (HODQ) was used to determine severity of dysphagia via a grading scale of none (0), mild (1-20), moderate (21-40) and severe (>40). Motility was classed as normal (NOM), Ineffective (IOM) or Absent Contractility (AC) according to the Chicago Classification of Motility Disorders 4.0. GORD was classified by acid exposure time (AET). No GORD (NG – AET<4%), borderline GORD (BG – AET 4-6%), pathological GORD (PG – AET >6%) (Lyon 2.0). The manometric presence or absence of a hiatus hernia (HH) was also assessed. The Cochran-Armitage (CA) trend test and chi-square test were used for statistical analysis.Results 1457 patients between 18 and 92yrs [median 55yrs, 586 (40%) males and 871 (60%) females] were included. 310 (21.3%) reported no dysphagia, 907 (62%) mild, 211 (14.5%) moderate, and 29 (2%) severe. Increased dysphagia severity was significantly associated with pathological GORD ( ptrend =0.009). Ordinal logistic regression (OLR) confirmed this association (OR=1.32, 95%CI 1.06-1.64, p=0.014). There was no significant association between the presence of a HH and dysphagia with GORD (X2(1) =0.56, p=0.45, OR=0.84, 95% CI 0.52-1.34).No significant association/linear trend was observed between dysphagia severity and IOM or AC in comparison to normal motility. Similarly, GORD status (borderline or pathological) showed no association or linear trend with IOM or AC when compared to normal motility (all ptrend > 0.05).Conclusions Increasing dysphagia severity is significantly associated with pathological GORD. However, this is not associated with Ineffective Oesophageal Motility, Absent Contractility or HH. This suggests that dysphagia pathogenesis in GORD is due to oesophageal hypersensitivity related to the neuroinflammatory response rather than anatomical features (HH) or oesophageal motility.Abstract P396 Table 1CA trend analyses comparing dysphagia, GORD, and impaired motility.Comparisonptrend value rangeTrend?Dysphagia v PGptrend 0.009; OR 1.32PG increases with severityDysphagia v IOM/AC0.11–0.29NoPG v IOM/AC0.96–0.99NoBG v IOM/AC0.73–0.88No