Gastroesophageal reflux disease (GERD) is a common condition, with multifactorial pathogenesis, affecting up to 40% of the population. Obesity is also common. Obesity and GERD are clearly related, both from a prevalence and causality association.

GERD symptoms increase in severity when people gain weight. Obese patients tend to have more severe erosive esophagitis and obesity is a risk factor for the development of Barrett's esophagus and adenocarcinoma of the esophagus. Patients report improvement in GERD when they lose weight and there are several reports suggesting a decrease in GERD symptoms after bariatric surgery.

Fig: Summary of potential pathogenic mechanisms in the obese leading to GERD.

‘How Obesity cause GERD?

Obesity, especially abdominal obesity, was the significant risk factor for erosive esophagitis.

The notion of obesity as a cause of GERD is biologically plausible. Obesity has been associated with increased intra-abdominal pressures, impaired gastric emptying, decreased lower esophageal sphincter pressure, and increased frequency of transient sphincter relaxation, thus leading to increased esophageal acid exposure.

Overweight and obesity are strong independent risk factor of GERD symptoms and esophageal erosions.

In patients with GERD, higher BMI was associated with more frequent and more severe heartburn and regurgitation, as well as with esophagitis. Obese participants were 2.5 times as likely as those with normal BMI (<25) to have reflux symptoms or esophageal erosions. 

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