Dysphagia After Bariatric Surgery:

Tackling Complications Through IDDSI Integration and SLP Care

By: Dr. Kevin Huffman, D.O., Board Certified Bariatric Physician; Co-author & Editor: Karen Sheffler, MS, CCC-SLP, BCS-S of SwallowStudy.com

Introduction to Bariatric Surgeries

With over 25 years as a bariatric physician specializing in weight loss surgery and medical management, I have guided countless patients through procedures like gastric sleeve, Roux-en-Y gastric bypass, and banding. Before this article addresses post-bariatric surgery dysphagia, let’s review these 3 procedures.

Gastric sleeve surgery, also known as sleeve gastrectomy, involves removing approximately 80% of the stomach, leaving a smaller, tube-shaped pouch that restricts food intake and promotes significant weight loss. Image created by Dr. Huffman for this article on AmBari.

Roux-en-Y gastric bypass creates a small pouch from the upper stomach and connects it directly to the small intestine, bypassing a portion of the digestive tract to reduce both food consumption and nutrient absorption. Image created by Dr. Huffman for this article on AmBari.

Adjustable gastric banding places an inflatable silicone band around the top of the stomach to form a small pouch, limiting food intake while allowing for adjustments over time without cutting the stomach or intestines. Image created by Dr. Huffman for this article on AmBari.

These surgeries transform lives by addressing obesity. However, difficulty swallowing (dysphagia) often emerges as a complication that affects nutrition, healing, and quality of life. Informed by clinical experience and recent research, including insights from experts like Karen Sheffler, MS, CCC-SLP, BCS-S at SwallowStudy.com, I would like to explore and discuss how dysphagia develops post-surgery.

I will cover its potential risks and how the International Dysphagia Diet Standardisation Initiative (IDDSI) framework can be integrated into bariatric diet plans to ensure safer and more effective and efficient eating and drinking.

How Dysphagia Develops After Bariatric Surgery

Dysphagia often comes from changes in the body’s structure and function caused by bariatric surgery, but read on to see just how multifactorial it can be. 

In sleeve gastrectomy, where about 80% of the stomach is removed to make a tube, narrowing/stenosis or strictures can form due the following factors:

• scar tissue pulling back,
• extra stitching on the staple line, or
• uneven stapling that creates a sharp bend or twist in the sleeve.

Blockages such as these make it hard for food to pass, causing symptoms like food getting stuck or pain. In my practice, I’ve noticed that eating hard solid foods too soon can make these problems worse and affect the healing process. Nath et al. (2016) explained how pulling too hard during stapling or small blood clots during healing can build scar tissue, leading to stenosis.

Early swelling and inflammation after surgery can make swallowing harder in the first few weeks. Read on it this article to learn more about when, where, and how this swelling occurs. 

Over time, weight loss that is too quick can weaken the muscles used for swallowing (e.g., sarcopenia and dysphagia has been well researched over the last decade). If a person has difficulty swallowing and is not drinking enough water, that can make secretions thicker, which will in turn make it harder to swallow.That may also lead to poor oral health and oral frailty, placing a person at an increased risk for aspiration pneumonia. 

Conditions that were present before surgery can make these problems worse: 

• Reflux – which can get worse after surgery – irritates the esophagus, leading to spasms or sores (esophagitis);
• Diabetic neuropathy slows down gut movement;
• Hypothyroidism can slow down the digestive system and make esophageal and stomach peristalsis sluggish; and 
• Thiamine deficiency (common after surgery) can cause nausea and poor gut function.  I have noticed that simple thiamine supplements often help ease these symptoms.

Pain medicines like opioids and anti-inflammatory drugs like NSAIDs can also slow motility by relaxing the sphincters or damaging the mucosa.

In some rare cases, rapid weight loss can unmask underlying vascular issues, such as dysphagia lusoria, where an aberrant right subclavian artery (ARSA) compresses the esophagus (Bryner et al., 2022). This may occur due to the loss of the peri-esophageal fat pad, which normally cushions the area. For example, Bryner and colleagues described a case study of a 49-year-old woman who developed dysphagia lusoria two months after Roux-en-Y gastric bypass, with symptoms resolving after vascular surgery to reposition the ARSA. A similar report involved a 23-year-old woman experiencing dysphagia five months post-laparoscopic gastric bypass, also treated successfully with surgery (Fabian et al, 2004). These examples highlight how weight loss can reveal hidden anatomical anomalies, underscoring the need for thorough evaluation if symptoms persist.

Dysphagia Onset & Potential Longer-Term Problem

In general, symptoms of dysphagia typically peak within the first 30 days but can persist or emerge later. Studies have reported dysphagia up to 2 years post-surgery (Miller et al., 2020). Collaboration across related disciplines is crucial. Gastroenterology (GI) evaluates with endoscopy (scope of esophagus through stomach into the beginning of small intestine), high-resolution impedance manometry (HRIM), and more. HRIM testing reveals major motility disorders in 26% of symptomatic patients (Hathorn et al., 2020).

In my American Bariatrics clinics, prompt assessments like these, frequently supported by SLPs using MBSS to visualize swallowing dynamics, have prevented minor problems from escalating into major setbacks.

Collaboration with Speech-Language Pathologists Who Specialize in Swallowing

Speech-Language Pathologists (SLPs) play a vital role in identifying swallowing difficulties, such as differentiating oral and pharyngeal issues from pharyngoesophageal and esophageal dysphagias. This means finding out what difficulties are in the mouth and/or throat versus what is a suspected problem in the esophagus and with esophageal emptying (helping the SLP and the medical team make appropriate and timely referrals to gastroenterology/GI). SLPs play a critical role assessing swallowing function and recommending tailored interventions.

The SLP may start with a thorough bedside swallowing evaluation, including chart reviewing and interviewing the person and caregivers to tease out potentially related comorbidities (past medical problems). The SLP will ask about baseline problems (i.e., something you have struggled with for years) versus what are all the current signs and symptoms. You, your SLP, and the rest of the medical team can track your quality of life and swallow function over time with Patient Reported Outcome Measures or PROMs (e.g., EAT-10 in English and in Spanish; as well as the Reflux Severity Index/RSI and many more).

Thorough testing is needed to visualize the actual swallow (see inside) to examine the structures and function from the mouth through the esophagus, using a motion x-ray study called: the Modified Barium Swallow Study (MBSS), also known as the Videofluoroscopic Swallow Study (VFSS). The MBSS evaluates the severity of the dysphagia and identifies the safety risks for aspiration (i.e., if food/liquid/pills get down the wrong way below the larynx/voice box and into the trachea and lungs). It also evaluates the efficiency of the swallow (i.e., if residue is getting stuck in the mouth, throat, or esophagus, and/or coming back up). The study’s ultimate purpose is to identify specific problems and figure out what to do about them. The SLP will offer many options of safer swallowing strategies and diet modifications, and the motion x-ray will help you see how these help you swallow better or not. 

More Details on Instrumental Swallow Studies:

These are an essential part of a comprehensive dysphagia evaluation. We have two main instrumental examinations: the MBSS/VFSS and the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The first study of choice for the specific issues facing people post-bariatric surgery would be the MBSS/VFSS, as this can scan down the esophagus with the esophageal sweep or the Robust Esophageal Screening Test (Click here for more info on the REST).

The MBSS:

• Watches you eat and drink a variety of consistencies and take a barium pill (as tolerated);

• Analyzes with frame-by-frame viewing after the study;

• Identifies the safety and efficiency of your swallow through the oral through esophageal phases, using an esophageal sweep to scan for items getting stuck in the esophagus and if they are returning back up to the throat and airway;

• Gives you biofeedback during the exam (or at least ask to watch images after the exam) to understand your swallow and what worked;

• Designs compensatory options, diet modifications, and swallowing strategies for you to more easily maintain oral intake while further testing and treatment takes place; 

• Targets treatment and exercises to address the identified impairments; and

• Makes appropriate recommendations and referrals to your medical team to help guide your treatment course.

  

  The MBSS/VFSS views the swallow from a side view (like this lateral view – see black barium in the mouth) and from a front/straight-on view (AP view). SLPs analyze this motion x-ray movie of your swallow, using frame-by-frame analysis to find the underlying structural and physiological problems with the swallow that can be treated with targeted therapy.

Overall, the goals of comprehensive dysphagia evaluations may include the following: 

• Reduce the risks of aspiration and aspiration pneumonia;
• Reduce choking risks;
• Identify if food is getting stuck in the throat or esophagus, as peoples’ sensations of these can be poor (i.e., feeling like food is up in the throat when it is really down in the lower esophagus – called a referred sensation);
• Identify potential issues of muscle tension dysphagia and globus sensations (i.e., tightness building up in muscles and/or feeling a lump in the throat when no food/liquid/pill is identified as stuck);
• Add information about suspected reflux conditions versus esophageal backflow (aka, regurgitation of food/liquid back up to throat from the esophagus after the swallow) and refer to gastroenterology.

The SLP can help people regain safe and efficient swallowing function through rehabilitation and exercises as needed. The SLP is a key part of the person’s medical team, as often the first step of a targeted therapy plan is making the right referrals to help fix and/or compensate for the problems.

It is important to know that the SLP cannot make a diagnosis. Additionally, the SLP cannot fully evaluate the esophagus, test for reflux, examine the lower esophageal sphincter, or rate the esophageal and stomach emptying. However, the SLP will refer back to that medical team, making appropriate referrals and collaborating across the following disciplines:

• radiologist for other fluoroscopic studies, such as the esophagram/upper GI barium swallow, timed barium swallow, and gastric outlet studies.
• surgical team and gastroenterology (GI): for the full investigations needed to diagnose oropharyngeal versus pharyngoesophageal, esophageal, GE junction, esophageal outlet disorders, esophageal motility disorders, and more. They may use endoscopy and/or high resolution impedance manometry to differentiate structural versus esophageal motility-based issues. 
• registered dietitian nutritionists (RDN) to ensure adequate food, liquid, and nutrient intake and reduce the risk of malnutrition and dehydration.
• Collaborate across the medical team, including the primary care physician, to reduce any negative consequences, such as a hospital readmission. 

Risks of Dysphagia in People Post-Bariatric Surgery 

How Common is Post-Bariatric Surgery Dysphagia?

The chance of developing dysphagia after bariatric surgery can be quite high, and it depends on the type of procedure. The Miller and colleagues’ large 2020 study found that 13.7% of 271 patients had noticeable dysphagia about 3.9 years after surgery. However, that 13.7% number was likely even low, as it was based on a survey only.

Nath et al. (2016) reported that 22.7% of patients had dysphagia after a sleeve gastrectomy, not counting short-term cases. 

Even without a visible blockage or mechanical obstruction, Hathorn et al. (2020) found up to 30% of patients still had dysphagia symptoms and 48% showed abnormal esophageal manometry (including 22.1% with minor disorders and 26% with major disorders such as achalasia at 3.9%). The authors summarized in their results section:

“Major disorders on HRM were more common in lap band patients compared to non-lap band (RYGB or sleeve gastrectomy) patients (46.2% vs 21.9%, p=0.05).”

In a separate three-center study of 137 patients (sleeve + bypass), Miller et al. (2020) used HRIM and discovered 12.4% of individuals with abnormal esophageal swallowing patterns. More on this in the next section of Key Dysphagia Risk Factors – under Time & Weight.

Together, these numbers show why every bariatric patient deserves a comprehensive swallowing evaluation by an SLP specializing in swallowing (Find an SLP swallowing specialist) and a GI doctor, whether symptoms are obvious or not.

If left untreated, dysphagia can cause risks, such as: aspiration pneumonia, malnutrition, dehydration, and stalled weight loss. Persistent cases may require endoscopic dilatation or revision surgery.

Key Dysphagia Risk Factors Include:

Dysphagia risks can vary based on the type of procedure, as each changes the digestive system in unique ways. However, there are many other key risk factors to review here. 

• Procedure Type: 

  • Sleeve Gastrectomy: This has higher dysphagia rates mainly from strictures or narrowing. The surgery reshapes the stomach into a narrow tube, and scar tissue, uneven stapling, or twisting can block food flow, causing sticking or pain. It’s like squeezing a garden hose, food gets backed up. Early inflammation worsens it, but long-term, it might ease with stretching or dilatation.
  • Gastric Bypass: Here, dysphagia often comes from motility problems, like altered esophageal movement or high pressure in the new small pouch. This can mimic achalasia (reduced peristalsis) or lead to post-obesity esophageal dysfunction (POSED), where the esophagus loses its wave-like motion and pressure builds up in the stomach pouch. The rerouting bypasses parts of the stomach and intestine, disrupting normal wave-like contractions that push food down. Weight regain can make it worse by stressing the system.
  • Lap Band (Adjustable Gastric Banding): Shows more major disorders like band slippage, erosion, or stomal obstruction, which tighten the stomach entrance and cause food intolerance or severe nausea. The band is adjustable but can migrate or irritate over time, leading to chronic swallowing issues. Think of it as a too-tight belt around the stomach.

• Pre-existing Conditions: These common comorbidities (other conditions the person has) significantly amplify dysphagia risk:

  • Diabetes nearly doubles the risk by damaging the nerve that runs the esophagus (Nath et al., 2016).
  • Reflux (GERD) increases risk by chronic mucosal injury and spasm
  • Low thiamine (very common after bypass) brings nausea and weak peristaltic waves. A simple 100 mg pill twice a day can fix it in 48 hours.

• Operative & Post-Op Factors: 

  • Pain pills (NSAIDs or opioids) used in the first 6 weeks need to be considered, as noted above.
  • Larger endotracheal tubes and longer intubation times were found to be significant – based on related cardiac surgery studies, which have the same anesthesia setup we use in bariatric cases. For example, Plowman et al. (2021) studied heart-surgery patients and found:
    • An endotracheal tube size 8.0mm or larger triples the chance of aspiration post-extubation (i.e., food or liquid getting into the airway at 3.1 times higher odds).
    • Remaining intubated longer than 27 hours doubles that danger (2.1 times higher odds). 
    • Over half the patients swallowed inefficiently, and nearly everyone swallowed unsafely, yet most never coughed, so the problem stayed silent. 
  • Bottom Line: The bigger the tube staying in for longer time –> the more risk for getting food and liquid down the wrong way to the the airway and lungs, especially within the first week after surgery. An early SLP comprehensive dysphagia evaluation can catch this before you even leave the hospital.

• Time and Weight:

  • The longer it’s been since your surgery, the higher the chance of issues like achalasia or a condition called post-obesity esophageal dysfunction (POSED), where the esophagus loses its wave-like motion and pressure builds up in the stomach pouch. In the Miller and colleagues’ Post-obesity Surgery Esophageal Dysfunction study (2020), which looked at 97 post-bariatric patients (mostly sleeve or bypass) about 6 years after surgery, they found:
    • 12.4% had achalasia or POSED (none in pre-surgery group).
      • 7.2%: Achalasia alone 
      • 5.2%: POSED 
    • Longer time since surgery was independently associated with higher risk for major disorders, such as achalasia, POSED and other esophageal dysmotilities (e.g., median 12.5 years for achalasia). 
    • Weight regain (15% or more from your lowest) is also tied to major esophageal dysmotility (89.5% vs. 53% in those who kept weight off). 

• Other Risks:

  • Age 60+ adds additional risks as muscles weaken, esophageal and digestive motility can be reduced already, potentially mobility is declining, and a person’s amount of medications they are taking grows (i.e., polypharmacy = taking 5 or more medications concurrently). 
  • Kidney failure (stage 4-5) lets toxins stall the esophagus.

• Poor Awareness:

Add to the above risk factors the low awareness of dysphagia in general, highlighted by Pu and colleagues (2025) in their Awareness of Dysphagia: An Integrative Review, including:

• • • significantly low public awareness about dysphagia and even
    • limited knowledge base and skill within healthcare professionals.

   

  • further complicated by poor self-awareness within individuals – e.g., a person’s own sensation of exactly where the food is stuck is generally poor. See Marvin & Thibeault’s (2020) discussion of food bolus localization (i.e., pointing to where the food feels stuck). When people point to the throat, especially in that notch area at the base of the neck, that is often not accurate. The food is often actually stuck farther down in the esophagus. This is called a referred sensation, as the sensation of food stuck in the esophagus gets referred up to the neck area. Our esophagus is not wired well for sensation! This makes imaging essential. It is so important for the SLP to consider the esophagus when performing a comprehensive dysphagia examination, as Sheffler has been writing about for 10 years now in SwallowStudy.com.

Know & Reduce Risks for Post-Op Bariatric Surgery Dysphagia

Knowing these risks highlights the importance of early detection and management. 

One effective way to address dysphagia in bariatric patients is through adjusted diets, guided by tools standardized for over a decade by The International Dysphagia Diet Standardisation Initiative or IDDSI at IDDSI.org. The IDDSI Framework provides a common terminology of food and liquid levels, providing the characteristics and rationale for how each level may be used to help someone swallow in an easier and safer way. The trained healthcare professional can help match food and liquid textures to the person’s swallowing abilities while supporting recovery.

A Quick Overview of IDDSI for Bariatric Contexts

Throughout my career I’ve walked patients through the same four food phases after surgery before they can get back on a regular diet: Clear → Full → Pureed → Soft 

For bariatric patients, IDDSI refines post-op diets if dysphagia arises. I appreciate IDDSI’s simple testing methods, such as testing thickness with how fast liquid flows through a syringe or IDDSI Funnel over 10 seconds (more info on funnels). This IDDSI Fork Pressure Test can help people make sure the food is really soft and mashable with a fork. See the many IDDSI resources linked below.

Even without a dysphagia diagnosis, the IDDSI Framework provides a standardized and more detailed progression of the bariatric diet. Any person after a weight loss surgery is familiar with and trained in this progression.

IDDSI transforms that familiar sequence into a globally standardized scale with eight precisely defined texture levels. Each level is anchored by objective, reproducible tests (e.g., The IDDSI Flow Test for liquid thickness, IDDSI Fork-Pressure Test for food softness, and the IDDSI Spoon Tilt Test to make sure the puree is moist and smooth enough to slide off a spoon). 

Click here to view more English versions of the IDDSI documents: 

• Complete IDDSI Framework and Detailed Definitions
• IDDSI Framework Testing Methods
• Standards Overview: find documents in many languages, and learn how to cite IDDSI
• Go to the IDDSI Resources section for these posters and many other important resources.

See this Full IDDSI Framework Poster in English: https://www.iddsi.org/images/Publications-Resources/Poster/posterenglishinternational7august2024-press.pdf

IDDSI Levels Summary  

Listed below is a brief descriptor of each level from The IDDSI Framework.

Please note, according to the USIRG/United States IDDSI Reference Group’s best practice in terminology, 2 identifiers must be used – leading with name and then Level number. The USIRG Powerpoint that can be found here: https://www.iddsi.org/around-the-world/united-states 

• Thin, Level 0: Water-like.
• Slightly Thick, Level 1: Thicker than water, but similar to most formulas or liquid supplements; flows through straw.
• Mildly Thick, Level 2: Pours quickly from a spoon, but slower than thin drinks.
• Liquidised/Moderately Thick, Level 3: Can be drunk from a cup or spoon. Smooth and allows more time for oral control but needs more effort.
• Pureed/Extremely Thick, Level 4: eat with a spoon; fall off spoon in single spoonful, leaving little residue on spoon. 
• Minced & Moist, Level 5: Soft, moist, small lumps of 4mm x 4mm x 15 mm with no separate thin liquid. This requires minimal chewing.
• Soft & Bite-Sized, Level 6: Soft, tender and moist bite-sized pieces of 15 mm x 15 mm or 1.5 cm cubed. Soft = passes IDDSI’s Fork Pressure Test (mashable with a fork and does not return to original shape). Used to reduce choking risks.
• Easy to Chew, Level 7: This level does not reduce choking risks, as there are no bite-size restrictions. Soft and tender foods are fork pressure test “soft.” 
• Regular, Level 7: no restrictions; all foods.
• Transitional Foods: Not an IDDSI Level. These describe characteristics of certain foods that start at one level and change with temperature, moisture, and/or saliva added. No biting and minimal chewing required. Tend to dissolve to a paste if there is adequate saliva. Can be used across levels at the discretion of healthcare providers (e.g., to help begin a transition from purees to foods that have more texture).

General Guidelines for the Post-op Diet After Bariatric Surgery with Mapping to IDDSI Levels:

Chart created by Dr. Huffman, D.O.

Practical Advice for People with Post-Bariatric Surgery Dysphagia

• Get Checked Out Early: If you notice symptoms like pain or coughing while eating, reach out to your surgeon immediately. They can refer you to a GI doctor/gastroenterology and a Speech-Language Pathologist (SLP) right away. The following are some helpful tools: high-resolution manometry (HRM and HRM with impedance/HRIM), GI endoscopic procedures, MBSS/VFSS by SLP, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) by SLP as needed, and/or barium swallow studies with radiology. Check your swallowing, figure out what’s going on and how to fix it. Getting help early can stop small issues from becoming big problems.
• Use IDDSI Guidelines & Testing Methods: IDDSI uses tools that can be easily found in your home, such as spoons (Spoon Tilt Test) and forks (Fork Pressure Test). Try using these simple home tests to check the texture of your food, following the International Dysphagia Diet Standardisation Initiative (IDDSI.org) guidelines. If you need your liquid thickness adjusted to reduce aspiration risks, you can find a 10ml syringe from a healthcare provider or an IDDSI Funnel to test thickness with the IDDSI Flow Test.
• Don’t Forget the Protein: Focus on eating protein-rich, bariatric-friendly foods like pureed chicken (IDDSI Pureed, Level 4) to keep your strength up while keeping your meals easy to swallow and easy to pass through the esophagus and the stomach.
• Nutritional Fixes: Take care of any nutrient gaps, such as using thiamine supplements if your doctor suggests it, since this is common after surgery. 
• Pain Management: Try to cut back on pain medicines like NSAIDs or opioids, which can make swallowing harder. Ask your doctor for safer options.
• Simple Habits: Eat small meals while sitting up straight to help food go down smoothly and with the help of gravity. You may eat 6 small meals a day or 3 meals plus supplements in between (follow your RDN and surgeon’s recommendations). General strategies are to eat slowly, avoid chugging liquids, and chew your food really well. 
• Follow Safer Swallowing Strategies from SLP: Based on your comprehensive dysphagia evaluations, you could see inside yourself to know what worked and what didn’t work. Hopefully strategies were found to make swallowing easier, more functional, and more comfortable while other testing and treatments are underway. 
  • This process is different for everyone, so find out your customized set of strategies from the SLP’s findings. 
  • Some people may need to alternate liquids and solids (i.e., after every 1-3 bites of food, take a sip of liquid). 
  • Your SLP may have recommended drinking thickened liquids to reduce your risks or aspiration, strain, and distress. Your MBSS/VFSS may have shown that you are aspirating before or during the swallow due to an additional oropharyngeal dysphagia (i.e., due to inflammation from your endotracheal tube or from an unrelated baseline oropharyngeal dysphagia). You may have aspiration risk after the swallow if liquids are staying in the esophagus and coming back up after the swallow. 
    • Sometimes this aspiration risk can be reduced with small sips or other maneuvers. 
    • Other times, thickened liquids may be a good option. If you are on thickened liquids, make sure to stay hydrated. 
    • Please note, that thicker is not always better, as if the liquid is too thick, the movement of liquids through the esophagus may be slower and exacerbate esophageal dysmotilities.
• Keep Track of Progress: Many cases of dysphagia improve within a few months, but if it lingers, you might need treatments like dilatation—where about 69% see improvement according to Nath et al. (2016)—or even revision surgery. Keep an eye on how you’re doing and check in with your healthcare team regularly. Participating in a bariatric support group can also provide valuable encouragement and shared experiences during this time.
• Personalized Management: Above all, talk to your medical team (i.e., surgeon, GI, SLP, RDN) to create a plan that fits your needs. They can tailor advice and exercises to your situation, helping you manage dysphagia in a way that works best for you.

Summary of Post-Bariatric Surgery Dysphagia 

When dysphagia shows up after bariatric surgery, it will feel like a setback, but it is something you can usually handle with good strategies. Tools like The IDDSI Framework help you and your team use a standardized diet system and testing methods to adjust your recovery moving up the IDDSI Levels. In the past, doctors have recommended vague diets, like “soft foods,” without any specific definitions, descriptions or testing methods. Now with IDDSI, clear levels of foods and drinks can match to what your swallowing can handle, making meals safer and aiding your healing. If dysphagia does develop, Speech-Language Pathologists (SLPs) are especially important. SLPs specialize in evaluating and working with you to hopefully fix the swallowing problems, often preventing bigger issues like aspiration, aspiration pneumonia, malnutrition, and long hospital stays. Be proactive in teaming up with your doctors, including SLPs, to create a plan that fits you. Taking active steps like this helps many people move past post-bariatric surgery dysphagia and keep progressing toward better health.

Thank you to the researchers advancing this field.

About the Author & Collaboration:

Kevin D. Huffman D.O., a board-certified bariatric physician, has treated over 10,000 patients in his bariatric medical career and trained and mentored hundreds of physicians and allied healthcare providers. A nationally recognized leader in the bariatric medical community, Dr. Huffman has been called upon by medical/surgical societies, pharmaceutical/surgical companies, patients and hospitals to lecture and consult in the art, science and business of bariatric medicine.

As the Founder and President of American Bariatric Consultants, Dr. Huffman draws upon nearly three decades of developing treatment protocols, writing training manuals, inspecting doctors’ offices and hospital programs. He also mentors and prepares physicians for board certification in bariatric medicine in order to help physicians, surgeons and hospitals enter the bariatric treatment community.

Dr. Huffman graduated from Baldwin Wallace College in 1983, and then graduated from Ohio University Heritage College of Osteopathic Medicine in 1987. Connect with Dr. Huffman on LinkeIn.

Disclosures: As the medical director of AmBari Nutrition, Dr. Huffman oversees the development of nutrition products and programs tailored for bariatric patients. For more details on his background, visit his short bio on AmBari’s website.

Dr. Huffman, Karen Sheffler, SwallowStudy.com, and SwallowStudy & Associates, LLC are not receiving any financial incentives to write this article.

Dr. Huffman and Ms. Sheffler enjoyed this terrific collaboration. Dysphagia is a topic in which both our fields are so connected to, but unfortunately there is not enough public information and resources out there. That is where SwallowStudy.com has come in for the past 10 years! Thank you for reading, discussing, commenting, and sharing.

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References

For Post-bariatric surgery dysphagia and more:

• AmBari Nutrition. (2025, January 21). Gastric sleeve diet plan: What to eat before and after surgery. https://www.ambarinutrition.com/blogs/health-and-weight-loss-journal/complete-guide-to-vsg-gastric-sleeve-diet-before-and-after-surgery
• Belafsky, P. C., Mouadeb, D. A., Rees, C. J., Pryor, J. C., Postma, G. N., Allen, J., & Leonard, R. J. (2008). Validity and reliability of the Eating Assessment Tool (EAT-10). The Annals of otology, rhinology, and laryngology, 117(12), 919–924. https://doi.org/10.1177/000348940811701210
• Belafsky, P. C., Postma, G. N., & Koufman, J. A. (2002). Validity and reliability of the reflux symptom index (RSI). Journal of voice : official journal of the Voice Foundation, 16(2), 274–277. https://doi.org/10.1016/s0892-1997(02)00097-8
• Benites-Goñi, H., et al. (2024). Early and severe onset of esophageal dysfunction after laparoscopic sleeve gastrectomy: A case report and review of literature. Revista de Gastroenterología del Perú, 44(1), 63-66. https://pubmed.ncbi.nlm.nih.gov/38734913/
• de Sire, A., Ferrillo, M., Lippi, L., Agostini, F., de Sire, R., Ferrara, P. E., Raguso, G., Riso, S., Roccuzzo, A., Ronconi, G., Invernizzi, M., & Migliario, M. (2022). Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients, 14(5), 982. https://doi.org/10.3390/nu14050982
• Hathorn, K. E., Redd, W. D., Jirapinyo, P., Runge, T., Thompson, C. C., & Chan, W. W. (2020). S1198 Esophageal dysmotility following bariatric surgery: Is there an association with weight regain? The American Journal of Gastroenterology, 115(Suppl.), S595. https://journals.lww.com/ajg/fulltext/2020/10001/s1198_esophageal_dysmotility_following_bariatric.1199.aspx
• Kourek, C., Labropoulou, V., Michou, E., & Dimopoulos, S. (2025). Incidence and risk factors of dysphagia after cardiac surgery: A scoping review. Journal of Clinical Medicine, 14(12), 4279. https://www.mdpi.com/2077-0383/14/12/4279
• Marvin, S., & Thibeault, S. (2020). Pharyngeal Versus Esophageal Stasis: Accuracy of Symptom Localization. American journal of speech-language pathology, 29(2), 664–672. https://doi.org/10.1044/2019_AJSLP-19-00161
• McHutchion, L. D., Pringle, J. M., Tran, M.-H. N., Ostevik, A. V., & Constantinescu, G. (2025). Awareness of dysphagia: An integrative review. Perspectives of the ASHA Special Interest Groups, 10(3), 974–990. https://pubs.asha.org/doi/10.1044/2025_PERSP-24-00293
• Miller, A. T., Matar, R., Abu Dayyeh, B. K., Beran, A., Vela, M. F., Lacy, B. E., Crowell, M. D., Geno, D. M., Lavey, C. J., Katzka, D. A., & Ravi, K. (2020). Postobesity surgery esophageal dysfunction: A combined cross-sectional prevalence study and retrospective analysis. American Journal of Gastroenterology, 115(10), 1669-1680. https://mayoclinic.elsevierpure.com/en/publications/postobesity-surgery-esophageal-dysfunction-a-combined-cross-secti. Other links to same:
  • Miller, A. T., Ravi, K., Abu Dayyeh, B. K., & Katzka, D. A. (2020). Postobesity surgery esophageal dysfunction: A combined cross-sectional prevalence study and retrospective analysis. The American Journal of Gastroenterology, 115(10), 1669–1680. https://pubmed.ncbi.nlm.nih.gov/32558689/
  • Miller, A. T., Matar, R., Dayyeh, B. K. A., & et al. (2020). Postobesity surgery esophageal dysfunction: A combined cross-sectional prevalence study and retrospective analysis. American Journal of Gastroenterology. Advance online publication. https://www.endoscopy-campus.com/en/ec-news/dysphagia-is-common-after-bariatric-surgery/
• Moganasundaram, S., Tierney, A., Smedira, N. G., Blackstone, E. H., & Allen, L. A. (2021). Dysphagia after cardiac surgery: Prevalence, risk factors, and associated outcomes. The Journal of Thoracic and Cardiovascular Surgery. Advance online publication. https://www.sciencedirect.com/science/article/pii/S0022522321004050
• Nath, A., Yewale, S., Tran, T., Brebbia, J. S., Shope, T. R., & Koch, T. R. (2016). Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention. World Journal of Gastroenterology, 22(47), 10371–10379. https://pmc.ncbi.nlm.nih.gov/articles/PMC5175249/
• Pu, D., Liu, J. & Yao, T.J. (2025). Awareness of dysphagia: An integrated review. SIG13 Swallowing and Swallowing Disorders (Dysphagia), 10(3), 974-990. https://doi.org/10.1044/2025_PERSP-24-00293
• Watts, S., Gaziano, J., Jacobs, J. & Richter, J. (2019). Improving the diagnostic capability of the modified barium swallow study through standardization of an esophageal sweep protocol. Dysphagia, 34, 34-42. https://www.ncbi.nlm.nih.gov/pubmed/30635777
• Watts, S., Gaziano, J., Kumar, A. & Richter, J. (2019, March). The diagnostic accuracy of an esophageal sweep protocol. Poster presented at Dysphagia Research Society Annual Meeting, San Diego, CA.

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Need More Dysphagia Resources & Recipes?

• In addition to IDDSI links above, here is my IDDSI Resources Update.
• For more reading on IDDSI Levels, The IDDSI Framework, IDDSI Testing Methods, delicious recipes, and dysphagia information written for the public, Diane Wolff (author) teamed up with Karen Sheffler and others for the MayoClinic Press to bring you this cookbook: Cooking for Dysphagia and Other Swallowing Disorders, which features:
  • 101 delicious and safe recipes designed for busy caregivers
  • The latest IDDSI standards and guidelines for pureed food
  • Budget-friendly tools for creating a dysphagia-friendly kitchen
  • Essential ingredients to stock your pantry, fridge, and freezer
  • Tips to batch meal preparation—saving time, money, and effort
  • Guidance on making pureed food more appealing through presentation, color, and texture
  • Contributions from Harvard’s Dr. Walter Willett, medical speech-language pathologists Karen Sheffler (note: financial disclosure in sharing the cookbook here) and Theresa Richard, and chef Andrew Cullum.
• See another dysphagia cookbook called: Modern Dysphagia Cooking, by John Holahan, B.S., M.B.A. is President and Founder of SimplyThick, LLC described by “SimplyThickJohn” in this blog.