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Background Obesity has been associated with reflux esophagitis.However, the association of metabolic syndrome with reflux esophagitis is unclear.Methods A case-control study of 372 subjects undergoing upper endoscopy during health check-ups was conducted (182 patients with reflux esophagitis vs 190 age and sex-matched controls).We further measured their height, weight,waist circumference, hip circumference, blood pressure,triglyceride, high-density lipoprotein and fasting blood glucose.Multivariable linear regression analysis was used to identify the independent risk factors associated with the presence of reflux esophagitis.Key Results Reflux esophagitis cases showed higher mean waist circumference (81.37±0.68 vs 79.36±0.70, P<0.05) , waist hip ratio(0.86±0.01 vs 0.84±0.01, P<0.05) and fasting blood glucose (5.59±0.10 vs 5.32±0.08, P<0.05)than controls.When adjusted for sex and age, multivariate analysis demonstrated that there was a positive dose-response relationship between reflux esophagitis and waist hip ratio (men: OR3.41,95%CI 1.52-7.62, women: OR 3.37, 95%CI 1.61-7.06), triglyceride (OR 2.07, 95%CI 1.12-3.82),fasting blood glucose (OR 1.81, 95%CI 1.12-2.94), and metabolic syndrome (OR 2.01, 95%CI 1.15-3.50), there was an inverse dose-response relationship between reflux esophagitis and high-density lipoprotein for men (OR 0.36, 95%CI 0.15-0.85).Conclusions & Inference High waist hip ratio, triglyceride, fasting blood glucose and metabolic syndrome were associated with increased risk factors for reflux esophagitis while high high-density lipoprotein for men correlated with a reduced risk of reflux esophagitis.