Ramin Niknam - Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz,
Alireza Manafi - Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
Sahar Khazforoosh - Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
Laleh Mahmoudi - Department of Pharmacotherapy, Shiraz University of Medical Sciences, Shiraz, Iran

Gastroesophageal reflux disease (GERD) is a very common disease. GERD is defined as the reflux of stomach content which causes troublesome symptoms and/or complications. The management of GERD is step by step. Dietary and lifestyle modifications are the first steps. Twice-daily H2RAs at standarddoses for a minimum duration of two weeks can be considered in patients with GERD who fail to respond to lifestyle and dietary modifications. If symptoms of GERD persist, once-daily Proton Pump Inhibitors (PPIs) can be recommended. Patients with an unsatisfactory response to once-daily PPIs dosingcan be considered to have refractory GERD. Twice-daily PPI therapy can be recommended in patients who fail to respond to once-daily PPI therapy. The add-on treatment with H2RAs, baclofen, or visceral pain modulators can be considered in selective subjects with GERD who fail to respond to twicedailyPPI. Anti-reflux surgery may be taken into account in selected patients. This review focuses on the initial and maintenance therapy of GERD and also reviews different management of recurrent and refractory GERD

Gastroesophageal reflux disease, Diagnosis, Treatment