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Introduction EJGOO is a motility disorder characterized by impaired relaxation of the EJG with preserved esophageal peristalsis. It has a reported prevalence of 16-18% in morbidly obese patients. Prevalence rates in other obesity classes have not been well established. Hence, we undertook a retrospective study to assess the association between obesity and EGJOO.Study Design Single-center retrospective database analysis.Methods All patients undergoing esophageal motility workups from 2017 to 2021 were analyzed, and the subset meeting the Chicago Classification v3.0 criteria for EGJOO was selected. The medical records were reviewed, and relevant demographic data and clinical data extracted.Results See table 1.46 patients were diagnosed with EGJOO. The mean age was 61 years. The average BMI was 28.98 and the average IRP was 21 mmHg. The majority had a normal barium swallow while presbyesophagus or hiatal hernia were noted in a few. EGD predominantly showed a normal esophagus. 25 patients (54%) had a hiatal hernia. 14 patients underwent EUS evaluation with no significant endosonographic findings seen.Discussion EGJOO was noted in symptomatic patients with mild to moderate obesity, with almost half the patients having a BMI ≥25. Obesity is well known to be associated with an increased risk of hiatal hernia, which was seen in our study population as well. 54.3% of our patients had evidence of hiatal hernia either on the barium swallow or EGD. No significant EUS findings were noted in these patients, consistent with prior studies.Limitations of our study include a limited dataset and a retrospective design. Further, the data set only included symptomatic patients who underwent HRM (prior studies have shown poor symptom-manometry correlation in obese patients). Larger prospective studies are needed to confirm the findings of our study. Obesity is associated with a lower likelihood of symptom resolution of EGJOO. Hence, further research on obesity as a modifiable risk factor for EGJOO is necessary.Abstract P143 Table 1shows demographic characteristics and key diagnostic findings in patients with EGJOOVariableResultDemographicsAge, yearsMedian 61 (31-96)Female / Male sex33 (72%) / 13 (28%)Body mass index (BMI)Mean BMI, kg/m228.9 ± 6.7Obesity (BMI ≥30 kg/m2)16 (34.7%)High-resolution manometryMean IRP, mmHg21.3 ± 5.2IRP ≥25 mmHg10 (21.7%)Barium esophagogramAny abnormality26 (56.5%)• Presbyesophagus8 (17.4%)• Hiatal hernia13 (28.2%)Upper Endoscopy (EGD)Any abnormalities (esophageal or gastric abnormalities)29 (63.0%)• Hiatal hernia25 (54.3%)• Esophagitis (LA grade A-B)4 (8.6%)• Barrett’s esophagus1 (2.2%)Endoscopic ultrasound (EUS)EUS performed14 (30.5%)• GEJ wall thickening (Layer 3 or 4)6 (13.0%)