Gastroesophageal reflux disease in the obese

Obesity and gastroesophageal reflux disease (GERD) are common conditions that both have been on the rise. The direct relationship between GERD symptoms and obesity has been demonstrated in many epidemiologic studies. The pathophysiological mechanisms that cause this relationship have also been proposed and include decreased pressure of the lower esophageal sphincter, increased episodes of transient lower esophageal sphincter relaxations, increased intra-abdominal and intragastric pressures, and hiatal hernia. Medical treatment with either weight loss or proton pump inhibitors is effective at treating GERD symptoms in the obese. Antireflux surgery in patients with elevated body mass index has been described with varied results. Bariatric procedures have also been evaluated for their effect on GERD, with laparoscopic gastric bypass offering the best results when compared with laparoscopic sleeve gastrectomy or laparoscopic adjustable gastric banding. Those with GERD and obesity may benefit from bariatric surgery, and referral for it should be considered.