**4. Conclusions**

Obesity is a major risk factor of GERD and has accounted for the rising GERD case, worldwide. The fundamental mechanisms in the development of GERD were found more frequently in patients with obesity. Accordingly, the frequency of reflux symptoms and mucosal complications of GERD were also higher in obese patients. Current available treatment options has highlight the benefit of weight loss in GERD patients with obesity, not only to improve the symptoms but also to enhance the response to GERD pharmacotherapy. Role of antiobesity pharmacotherapy is still limited in GERD patients. Those patients who failed the conservative medical therapy may be considered for surgical procedure to achieve weight reduction and improvement of GERD symptoms. The baseline reflux symptoms severity and mucosal injury are key factors in determining which patients that will benefit from surgery. The possible postoperative complication and available management options should be openly discussed with patients.
