Based on our new findings in asymptomatic volunteers, waist belt and central obesity cause partial hiatus herniation and short-segment acid reflux. This provides a plausible explanation for the high incidence of inflammation and metaplasia and occurrence of neoplasia at the GOJ in subjects without a history of reflux symptoms.

For more detailed proposed mechanism see:

Waist belt and central obesity cause partial hiatus hernia and short-segment acid reflux in asymptomatic volunteers.

Yeong Yeh Lee, Angela A Wirz, James G H Whiting, Elaine V Robertson, Donald Smith, Alexander Weir, Andrew W Kelman, Mohammad H Derakhshan, Kenneth E L McColl.Gut 09/2013; ·

It has long been hypothesized that visceral adiposity, expressed by an increased abdominal waist circumference, could be associated with increased intra-abdominal pressure which promotes carditis by increasing intragastric pressure. Furthermore obesity might determinate increased intra-abdominal pressure that results in extrinsic gastric compression by visceral fat with a subsequent increase in intragastric pressure and gastroesophageal pressure gradient as well as an increased risk for developing a hiatal hernia. In obese patients other factors that play a role are esophageal peristaltic abnormalities, such as incompetence of the lower esophageal sphincter, nutcracker esophagus and non-specific motility disorders

Carditis may be due to H. pylori infection of cardias. A relationship between Helicobacter pylori and obesity has been recently raised by epidemiological data as well as by the reduction of ghrelin levels induced by the bacterium.

Thank you very for very thoughtful comments.

would you provide me a copy of paper (s) showing any significant positive association between obesity and H.pylori infection please.

Here you will find two attached papers concerning the relationship between H. pylori and ghrelin. The association of bacterial presence and obesity has beenreported in a recent International meeting (Bridging Meeting, Berlin 15-16 November 2013) in a study involving more than 1000 patients.

You will find attched the supplemental paper.

Dear Mohammad Derakhshan, a possible association between obesity/related illness and H. pylori infection is suggested even in the Guidelines Maastricht 2012: statement 13, evidence level 2b, grade of recommendation B.