Esophageal reflux should be treated only if symptoms are severe enough for patients to seek therapy or if esophagitis results. One study found that the number of reflux episodes lasting more than 5 min was the best indicator of esophagitis. Factors such as efficiency of the antireflux barrier, esophageal clearing, and aggressive power of refluxed material impact on the pathogenesis of reflux esophagitis. Therapy should be aimed at these factors and depends on severity of disease. Dietary measures, postural measures, and drug therapy can be used to alleviate symptoms and/or improve healing of esophageal lesions, with surgery recommended only in rare cases. Antacids, Gaviscon, and motor-stimulating drugs (metoclopramide, domperidone, bethanechol) may be sufficient to treat pathologic reflux without esophagitis. Once erosive or ulcerative lesions have developed, more rigorous medical treatment including H2 receptor blockers is mandatory.