The study analyzed the effect of central obesity on esophageal motility and mucosal barrier function in 185 patients using non-contrast abdominal CT, where the ratio of visceral and subcutaneous fat (V/S) was used for stratification into quartiles Q1–Q4. Group Q1 (V/S ≤ 1.01, n=48) had a mean age of 52.75 years and a median BMI of 30 kg/m²; Q2 (1.02 < V/S < 1.29, n=45): age 56.62 years, BMI 25.95 kg/m²; Q3 (1.30 < V/S < 1.75, n=46): age 58.43 years, BMI 24.11 kg/m²; Q4 (V/S ≥ 1.76, n=46): age 60.65 years, BMI 25.67 kg/m². The prevalence of GERD increased from 22.92% in Q1 to 54.35% in Q4, with significant differences (P < 0.05) in sex, GERD, lower esophageal sphincter (LES) pressure, EGJ contractile integral (EGJ-CI), acid exposure time (AET), DeMeester score (DMS), and nocturnal impedance (MNBI). After adjusting for hiatal hernia and other factors, the V/S ratio was positively correlated with LES pressure, EGJ-CI, AET, and DMS, but negatively with MNBI. The strongest associations were in the Q4 group, where central obesity impairs esophageal motility, weakens the mucosal barrier, and causes mucosal damage by acid reflux.