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Background: Hypertension of the upper esophageal sphincter (UES) is frequently encountered on manometries performed for evaluation of foregut symptoms. Although the clinical significance of a hypertensive UES is variable, it has been suggested that it may be a result of esophageal acid exposure in patients with gastroesophageal reflux disease (GERD). There is no evidence in the literature to support this theory. We hypothesized that successful control of acid reflux with surgery in patients with GERD may lead to resolution of UES hypertension, if it is a reflux-related phenomenon.Methods: A prospectively maintained database of patients undergoing antireflux surgery at our institution was retrospectively reviewed for the years 2006 to 2009. Only patients with hypertensive UES (>120mmHg), preoperative objective findings of GERD and subsequent primary antireflux surgery were included in our analysis. Preoperative UES pressure was compared to postoperative UES pressure, while resolution of reflux was confirmed with 24-hour pH study. Results: Thirty-three patients met the inclusion criteria. Thirty-one of those had normalization of their postoperative pH and two had reduction without complete normalization. The mean preoperative UES pressure was 154.3 mmHg (range 121.7- 250.3) (normal 30-120 mmHg) and decreased to a mean postoperative UES pressure of 122.9 mmHg (range 52.9-262.7) (p< 0.05). The statistical significance remained after excluding extremes. Twenty-seven patients had a decrease of the UES pressure (of which 18 had complete normalization), whereas 6 patients were found to have increased UES pressure after surgery. Both patients with abnormal postoperative pH studies had persistent hypertension of their UES. The mean length of time between surgery and postoperative manometry was 267 days.Conclusion: Patients with GERD and a hypertensive UES, who undergo anti-reflux surgery, demonstrate a significant reduction of their UES pressure. This may be considered supportive of the suggestion of an etiologic link between GERD and UES hypertension. Although the mechanism of this association is unclear, it appears to be reversible with anti-reflux surgery. Our results warrant further investigation in a prospective fashion for confirmation and assessment of the potential clinical impact.