Gastro-esophageal reflux disease and obesity, where is the link?

Abstract

The confluence between the increased prevalence of gastro-esophageal reflux disease (GERD) and of obesity has generated great interest in the association between these two conditions. Several studies have addressed the potential relationship between GERD and obesity, but the exact mechanism by which obesity causes reflux disease still remains to be clearly defined. A commonly suggested pathogenetic pathway is the increased abdominal pressure which relaxes the lower esophageal sphincter, thus exposing the esophageal mucosal to gastric content. Apart from the mechanical pressure, visceral fat is metabolically active and it has been strongly associated with serum levels of adipo-cytokines including interleukin-6 and tumor necrosis factor α, which may play a role in GERD or consequent carcinogenesis. This summary is aimed to explore the potential mechanisms responsible for the association between GERD and obesity, and to better understand the possible role of weight loss as a therapeutic approach for GERD.

Keywords: Body mass index, Visceral obesity, Gastro-esophageal reflux, Gastro-esophageal reflux disease complication

Core tip: This topic is aimed to explore the potential mechanisms responsible for the association between gastro-esophageal reflux disease (GERD) and obesity, that remain to be fully elucidated. Despite numerous evidence that show an increased risk of GERD symptom and/or complication in obese patients, the interplay between GERD and obesity is not clear. Based on the literature we have tried to summarize the evidence concerning the role of obesity in the GERD pathogenesis to better understand the possible role of weight loss as a therapeutic approach for this disease.