Altered gastrointestinal motility after bariatric surgery: consequences, complications and clinical considerations

Introduction: Bariatric surgical interventions such as laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), One-Anastomosis Gastric Bypass (OAGB) and Laparoscopic Adjustable Gastric Banding (LAGB) have proven to be effective in long-term management of obesity. These procedures result in changes in anatomy and in motor and secretory function of the gastrointestinal (GI) tract. Areas covered: This review covers the changes in gastrointestinal motility and their consequences observed after the various types of bariatric surgery. A systematic literature search on motility disorders of esophagus, stomach, small and large bowel until August 2025 was performed (PubMed). Expert opinion: Esophageal motility: a higher prevalence of dysphagia and post-obesity surgery esophageal dysfunction (POSED) is seen after bariatric surgery due to gastric restriction (intragastric high-pressure zone, esophageal outflow obstruction). Gastroesophageal reflux disease (GERD) is already common in people with obesity and may significantly increase after bariatric surgery depending on the type of procedure (LSG, not RYGB). Gastrointestinal motility: bariatric surgery results in significant acceleration of gastric emptying and of small intestinal transit (LSG > RYGB) with delay in colonic transit. Clinical considerations relevant for preoperative work-up, selection of bariatric procedure-type and postoperative follow-up of GI-motility disorders induced by bariatric surgery have been provided.