Background: Elevated integrated relaxation pressure (IRP) on esophageal high resolution manometry (HRM) identifies obstructive processes at the esophagogastric junction (EGJ). Aim: To determine if intrabolus pressure (IBP) can identify structural EGJ processes when IRP is normal. Methods: In this observational cohort study, adult patients with dysphagia and undergoing HRM were evaluated for endoscopic evidence of structural EGJ processes (strictures, rings, hiatus hernia) in the setting of normal IRP. HRM metrics (IRP; distal contractile integral, DCI; distal latency, DL; IBP; and EGJ contractile integral, EGJ-CI) were compared between 74 patients with structural EGJ findings (62.8 ± 1.6 yr, 67.6% F), 27 patients with normal EGD (52.9 ± 3.2 yr, 70.3% F), and 21 healthy controls (27.6 ± 0.6 yr, 52.4% F). Findings were validated in 85 consecutive symptomatic patients to address clinical utility. Results: In the primary cohort, mean IBP (18.4 ± 0.9 mmHg) was higher with structural EGJ findings compared to dysphagia with normal EGD (13.5 ± 1.1 mmHg, p=0.002) and healthy controls (10.9 ± 0.9 mmHg, p<0.001). However, mean IRP, DCI, DL, and EGJ-CI were similar across groups (p>0.05 for each comparison). During multiple rapid swallows, IBP remained higher in the structural findings group compared to controls (p=0.02). Similar analysis of the prospective validation cohort confirmed IBP elevation in structural EGJ processes but correlation with dysphagia could not be demonstrated. Conclusions: Elevated IBP predicts the presence of structural EGJ processes even when IRP is normal, but correlation with dysphagia is suboptimal.