Although GERD was initially described in the early 19th century, it is essentially a consequence of our modern day largesse. Dietary factors and associated obesity have com-bined with as yet other unknown factors (e.g. a decrease in the prevalence ofH. pylori?) to make GERD one of the most common diseases affecting western society. It is esti-mated that up to 20 million adults in the United States suffer from GERD, and treatment of these individuals consumes approximately $10 billion annually, the majority of it for prescription drugs used to manage the disease and its symptoms. Fortunately, despite challenges presented by co-factors resulting in GERD (diet, obesity, etc.), therapy of GERD is largely successful. However, even a low failure rate for a therapy used in the management of GERD still results in large numbers of affected patients because of the high prevalence of this disease. Use of a conservative estimate of a failure rate of 5% translates to 1 million ineffectively treated and unhappy patients. How to manage these patients is the subject of this book.

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