@article{AOE9284,
author = {Devvrat Yadav and C. Prakash Gyawali},
title = {Changes in esophageal physiology following weight loss interventions: a narrative review},
journal = {Annals of Esophagus},
volume = {9},
number = {0},
year = {2026},
keywords = {},
abstract = {Background and Objective: The prevalence of obesity is increasing, leading to renewed interest in medical, surgical and endoscopic interventions to promote weight loss. We aimed to explore available evidence regarding consequences of bariatric interventions to improve understanding of impact on esophageal function.Methods: Online databases (PubMed, Google Scholar) were systematically searched for English language studies published through December 31, 2025 that reported esophageal physiologic changes following bariatric interventions.Key Content and Findings: Obese individuals have higher likelihood of objective gastroesophageal reflux disease (GERD) and its complications compared to the non-obese. Diet and exercise reduce esophageal acid exposure time (AET), risk for erosive esophagitis and other GERD complications. Glucagon-like peptide 1 receptor agonists (GLP 1RAs) modestly increase risk of reflux disease, as well as erosive esophagitis, esophageal strictures and Barrett’s esophagus (BE). Among bariatric interventions, laparoscopic sleeve gastrectomy (LSG) increases risk of de novo GERD, with decreased lower esophageal sphincter tone and function, while Roux-en-Y gastric bypass (RYGB) reduces risk of reflux and can be offered to patients with pre-existing GERD. Esophageal hypomotility and achalasia-like syndromes are rare consequences of both LSG and RYGB. Obstructive syndromes can also be seen with laparoscopic adjustable gastric banding (LAGB), where the band may need to be deflated or removed. Endoscopic sleeve gastroplasty (ESG) has a more favorable post-procedure GERD profile compared to LSG. Other bariatric interventions including gastric balloons also promote GERD, but less objective data are available.Conclusions: Bariatric interventions impact esophageal physiology and symptoms, understanding of which can provide direction while planning these interventions. The risk of objective GERD and its complications decreases with diet and exercise while GLP-1RAs increase risk for GERD. Bariatric interventions produce measurable changes in esophageal physiology. LSG reduces lower esophageal sphincter (LES) resting pressure and raises intragastric pressure, resulting in elevated AET and de novo GERD; risk may be lower with ESG. In contrast, RYGB reduces AET, making it the preferred revision surgery for post-LSG patients with GERD. As newer bariatric interventions are developed and studied, understanding distinct esophageal physiologic consequences of each is essential for individualized patient counseling, appropriate procedure selection, and optimizing post-operative surveillance and management.},
issn = {2616-2784}, url = {https://aoe.amegroups.org/article/view/9284}
}