Achalasia 5 years following Roux-en-y gastric bypass

Abstract

Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES) is inhibited. This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food. The following case describes achalasia in a patient 5 years following a laparoscopic Roux-en-Y gastric bypass (RYGB). The patient underwent a laparoscopic Heller myotomy without a fundoplication. Although achalasia seems to be a rare occurrence in obese patients, this is the third case documented in a patient who previously had an RYGB. The role of performing a fundoplication in these patients remains to be elucidated.

Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature

“…Pseudo-achalasia occurring secondarily to gastric banding placement has been extensively reported, with a rather logical explanation that the banding placement acts as a factual gastroesophageal obstruction [40]. More recently, an increasing number of achalasia cases have been described after RYGB [36,41,42]. The first pathogenic mechanism underlying achalasia development may be the direct disruption of vagal fibers.…”

Achalasia after Bariatric Roux-en-Y Gastric Bypass Surgery Reversal

“…RYGP remains the most commonly performed bariatric procedure in the United States [19][20][21] . The risk of developing esophageal motility disorders, including achalasia, following bariatric surgery is still controversial and differs with the type of surgery [11][12][13][14][16][17][18] . Pseudoachalasia after LAGB placement has been described, though there is evidence that the pseudoachalasia may be reversible after the band is removed [11][12][13][14] .…”

“…In contrast, the development esophageal motility disorders after RYGB is rare and has only been reported a few times in the literature (Table 1) [ [15][16][17][18] . To the best of our knowledge, there are only 3 reported cases of achalasia after RYGB [16][17][18] , and this is the first case described after revision of RYGB. Interestingly, several case reports have been published on the simultaneous treatment of achalasia and morbid obesity with laparoscopic esophageal myotomy and gastric bypass [22][23] .…”

“…Primary achalasia is an idiopathic disease with unknown etiology, whereas secondary achalasia or pseudoachalasia is associated with infections, paraneoplastic syndromes and extrinsic compression by benign or malignant processes [4][5][6] . Interestingly, relationships have previously been reported between abnormalities in esophageal manometry, including achalasia, and both morbid obesity and bariatric surgery [7][8][9][10][11][12][13][14][15][16][17][18] . Most of the reported cases of achalasia after bariatric surgery occurred after laparoscopic adjustable gastric banding (LAGB) [11][12][13][14] .…”

“…Most of the reported cases of achalasia after bariatric surgery occurred after laparoscopic adjustable gastric banding (LAGB) [11][12][13][14] . Achalasia after Roux-en-Y gastric bypass (RYGB) is rare [15][16][17][18] and could be related to surgical trauma in the area [15] . In these cases, it is important to rule out stenosis of the gastrojejunostomy.…”