BMI affects presenting symptoms of achalasia and outcome after Heller myotomy

Obesity has reached epidemic proportions in the United States and worldwide. The impact of obesity on health is increasingly recognized; however, its impact on achalasia has not been established.

The present study was undertaken to determine the impact of body mass index (BMI) on the symptoms of achalasia and outcome after myotomy. In our institution, 262 patients have undergone laparoscopic Heller myotomy and scored their symptoms before and after myotomy on a Likert scale (frequency: 0 = never to 10 = every time I eat/always; severity 0 = not bothersome to 10 = very bothersome). Patients were stratified by BMI ≥ 30 kg/m² or BMI < 30 kg/m², and preoperative symptom scores and postmyotomy outcomes were compared.

Patients with BMI ≥ 30 had higher symptom scores for frequency of choking and vomiting before myotomy (p < 0.05). All symptom scores improved significantly after myotomy, except heartburn frequency and severity for patients with BMI ≥ 30. By regression analysis, increasing BMI tended to exacerbate the frequency of choking and vomiting before myotomy and the frequency of heartburn after myotomy. Among the patients with BMI ≥ 30 kg/m², 73% reported excellent or good outcomes compared to 91% for patients with BMI < 30 kg/m² (p = 0.02, Fisher’s exact test). However, 96% of patients with BMI ≥ 30 kg/m², as well as 93% of patients with BMI < 30 kg/m² would still elect to have the operation if they were asked to make the decision over again.

Although some preoperative symptoms are exacerbated by elevated BMI, all symptoms of achalasia are improved with myotomy, even when undertaken for obese patients.