Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications (Vakil, et al , 2006a). GERD results from the combination of excessive gastroesophageal reflux of gastric juice and impaired esophageal clearance of the refluxate. The three dominant pathophysiologic mechanisms causing gastroesophageal junction incompetence are: transient lower esophageal sphincter relaxations (tLESRs), a hypotensive lower esophageal sphincter (LES), and anatomic disruption of the gastroesophageal junction, often associated with a hiatal hernia. The dominant mechanism varies as a function of disease severity with tLESRs predominating with mild disease and mechanisms associated LES dysfunction and hiatus hernia predominating with more severe disease (Bardham CP, et al, 1995).