Esophageal Motility Disorders after Bariatric Surgery

Excerpt

A 45-year-old female who underwent a Roux-en-Y gastric bypass 10 years prior was referred to our GI clinic by a pulmonologist after an extensive negative workup for chronic cough. She also had complaints of severe regurgitation that did not respond to high-dose acid suppression therapy. An esophagogastroduodenoscopy (EGD) was performed which showed evidence of a tortuous and dilated esophagus. The lower esophageal sphincter (LES) was easily traversed with no narrowing noted. A fairly large gastric pouch was seen prolapsing into the esophagus (Fig. 1a). A barium study showed dilation of the thoracic esophagus, diminished contractility, and gastric pouch distention with compression at the LES (Fig. 1b). A high-resolution esophageal manometry (HRM) revealed aperistalsis in the body of the esophagus with normal LES pressures (Fig. 1c).

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