Dysphagia Is Common After Bariatric Surgery

Dysphagia Is Common After Bariatric Surgery

Prateek Sharma, MD, FASGE, reviewing Miller AT, et al. Am J Gastroenterol 2020 Jun 11.

Symptoms of dysphagia due to obstruction (mechanical or functional) can be caused by a noncompliant gastric pouch after bariatric surgery and, theoretically, could lead to the development of esophageal dysmotility. This retrospective study was designed to evaluate the prevalence of dysphagia and dysmotility in patients who had undergone bariatric procedures (Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy [LSG]).

Of the 137 patients (118 women; mean age, 54.6 years) included in this study, 97 had undergone bariatric surgery (LSG, 39; RYGB, 58) and 40 were prebariatric surgery candidates who had undergone high-resolution impedance esophageal manometry (HRIM) at least once. There was a higher prevalence of achalasia (7.2% vs 0%; P=.08) and postobesity surgery esophageal dysfunction (POSED; 5.2% vs 0%; P=.14), defined as aperistalsis and increased intragastric pressure, in the postsurgery group compared to the presurgery group. Major (22.5% vs 29.9%; P=.41) and minor (17.5% vs 30.9%; P=.14) esophageal motility disorders were not significantly different among the cohorts. HRIM performed for dysphagia more likely resulted in findings of achalasia or POSED (75%) and detected that “recurrent aspiration” was associated with POSED (20%). On endoscopy in the postsurgical group, 3 of 7 patients with achalasia and 1 of 5 patients with POSED were noted to have narrowing of the gastroesophageal junction. A longer lapse in time since surgery was independently associated with significant increases in the development of achalasia (median, 12.5 vs 5.8 years; P=.02), POSED (median, 15.0 vs 5.8 years; P=.02), and major motility disorders (6.6 vs 4.9 years; P=.01). Furthermore, in a cross-sectional survey of dysphagia symptoms in 271 patients who had undergone bariatric surgery, dysphagia was noted in 13.7% of the patients at a mean duration of 3.9 years after surgery.

Prateek Sharma, MD, FASGE


Dysphagia appears to be a common symptom after bariatric surgery. Achalasia, esophageal dysfunction, and major motility disorders can occur several years after bariatric surgery.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Miller AT, Matar R, Dayyeh BKA, et al. Postobesity surgery esophageal dysfunction: a combined cross-sectional prevalence study and retrospective analysis. Am J Gastroenterol 2020 Jun 11. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000000733)

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