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Background <p>Achalasia 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.</p> Objectives <p>To 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.</p> Methods <p>We 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.</p> Results <p>The 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 (<i>n</i> = 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 (<i>n</i> = 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.</p> Conclusions <p>In 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.</p>

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Achalasia and Esophageal Motility Disorders in the Bariatric Surgery Population: A Retrospective Descriptive Series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月18日

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  • Pattharasai Kachornvitaya,
  • Melissa V. Wills,
  • Baraa K. Mohamed,
  • Valentin Mocanu,
  • Juan S. Barajas-Gamboa,
  • Xinlei Zhu,
  • Yung Lee,
  • Ricard Corcelles,
  • Andrew T. Strong,
  • Suthep Udomsawaengsup,
  • Salvador Navarrete,
  • Jerry Dang,
  • Matthew Kroh

摘要

Background

Achalasia 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.

Objectives

To 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.

Methods

We 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.

Results

The 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.

Conclusions

In 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.