Lifestyle modifications should be discussed with every patient with symptoms of chronic gastroesophageal reflux disease (GERD). Proton pump inhibitors are the most efficacious medical therapy for GERD. H(2) receptor antagonists are likely to be effective in patients with mild to moderate GERD and for occasional symptoms. Promotility drugs have limited efficacy and produce frequent side effects. Surgery is a reasonable option for chronic management. Endoscopic therapy remains experimental until more long-term results are available.