ArticleObesity surgery2026
Achalasia and Esophageal Motility Disorders in the Bariatric Surgery Population: A Retrospective Descriptive Series.
Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAchalasia and severe obesity represent a rare but clinically challenging intersection. In patients undergoing bariatric surgery, esophageal motility disorders (EMDs), including achalasia and related conditions, may be pre-existing, unmasked, or develop following surgical alteration of foregut anatomy. Optimal treatment sequencing in this population remains poorly defined.
objectivesTo descriptively characterize clinical presentation, diagnostic features, and outcomes in patients treated for both severe obesity and EMDs, and to propose a preliminary treatment algorithm based on treatment sequencing.
methodsWe conducted a retrospective descriptive case series of patients treated between 2008 and 2023 at a single academic center. Among 7,054 patients who underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), 17 patients also underwent procedures for achalasia and EMDs were included. Patients were categorized by treatment sequence: achalasia treatment first (AF), bariatric surgery first (BF), or concurrent treatment.
resultsThe cohort had a mean age of 56.9 years and was predominantly female (70.6%). Type II achalasia was most common (41.2%). Patients treated for achalasia before or concurrently with bariatric surgery (n = 9) demonstrated generally favorable outcomes, with 12-month percentage total weight loss (%TWL) ranging from 20.2% to 49.6% and sustained symptom control in 66.7%. In contrast, patients treated for achalasia or EMDs after bariatric surgery (n = 8) experienced more heterogeneous clinical courses, with frequent need for additional interventions and variable symptom control, particularly following SG. Esophageal dysfunction occurred earlier after SG than after RYGB, and three of four SG patients (75%) required conversion to RYGB.
conclusionsIn this small descriptive series, treatment sequencing appeared to influence clinical outcomes in patients with severe obesity and achalasia or EMDs. Given the diagnostic complexity and heterogeneity of this population, these findings should be interpreted as hypothesis-generating. Larger, multicenter studies with standardized diagnostic criteria are needed to inform evidence-based management strategies.
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