Previous studies have indicated that obesity may cause EE by mechanical factors such as high intra-abdominal and intragastric pressure,39 an increased LES relaxation, a high gastroesophageal pressure gradient40; as well as physiological factors such as increased bile and pepsin composition of gastric contents41 and high leptin levels.42 Sleeve gastrectomy is currently leading up to 80% of weight loss in a long-term setting.43 A recent study demonstrated that a substantial reduction in BMI is required to induce the resolution of esophagitis, especially in individuals with obesity. This evidence concerns the gene LEP and obesity due to melanocortin 4 receptor deficiency.