Gastroesophageal reflux disease--one of the most common gastroenterological disorders--is characterized by reflux symptoms (occasionally respiratory symptoms or laryngeal complaints) and/or mucosal lesions. Improvement of symptoms and thus of the quality of life, prevention of relapse and of complications are the most important aims of short and long term treatment. Proton pump inhibitors are superior to histamine receptor antagonists and are the treatment of choice. Relapses occur in about 75% of patients within one year after stopping of acute treatment. The treatment strategy depends on the severity of symptoms and esophageal lesions. Patients with mild esophagitis or endoscopic negative disease can be treated with proton pump inhibitors on demand. In severe and complicated cases, the uninterrupted long-term use of proton pump inhibitors is indicated. In these cases laparoscopic fundoplication could be a possible--albeit problematic--alternative. New endoscopic interventional therapies should only be used in controlled studies. Their role in the treatment of GERD will only be known in a few years when adequately controlled long term studies will be available.