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

Table 1 Proposed mechanisms by which abdominal obesity causes reflux

Mechanical factors	Increased intra-gastric and gastro-esophageal pressure gradient
	Increased risk of Hiatal Hernia
	Increased sensitivity to distension-induced TLESR
	Decreased lower esophageal sphincter pressure
Humoral factors	Increased level of adipocytokines including interleukin 6 and tumor necrosis factor α
Motility disorders	Delayed gastric empting rate and delayed esophageal clearing time

TLSER: Transient lower esophageal sphincter relaxation.