**1. Introduction**

Occasional reflux of gastric content into the esophagus is a physiological phenomenon, until it presents with symptoms and/or mucosal complication, which defines the condition of GERD [1]. GERD is one of the most common diagnoses performed in a daily practice [2]. Clinically, GERD may manifest with cardinal symptoms of heartburn and regurgitation. Other symptoms are classified as esophageal (e.g., dysphagia, chest pain) and extraesophageal (atypical) symptoms [3]. GERD encompassed several subgroups, based on endoscopy and histopathological findings, such as erosive esophagitis, Barrett's esophagus, and nonerosive reflux disease (NERD) [3].

Recent evidence showed a rising prevalence of GERD and it was estimated 1.03 billion individuals are suffering from GERD globally [4, 5]. GERD has also become more prevalent nowadays in a previously uncommon region, such as Asia Pacific [6]. Excessive body weight is one of the multiple conditions that contribute to this escalation in GERD cases [7]. Yamasaki *et al*. in their study discovered a characteristic finding of GERD patients were primarily obese or severely obese [7]. Many of previous studies showed a common finding of reflux symptoms in patients with obesity, indicated an association between GERD and obesity [8]. The risk of both reflux symptoms and mucosal injury related to GERD is found to be increased in obesity [9]. Metabolic syndrome also appears to play a role in the development of GERD, since it independently increased the probability of NERD progression into erosive esophagitis [10]. Given the background of growing burden in both conditions, the following

sections will discuss the pathophysiology and available therapeutic modalities for GERD in obese individuals.
