This timely publication reviews cutting-edge knowledge and controversies associated with the diagnosis and treatment of GERD. It begins with a discussion of exciting new drug therapies which may impair transient lower esophageal sphincter relaxation and, if effective, may be particularly useful in patients with nonerosive or mild erosive reflux disease. Intestinal metaplasia of the cardia and whether it is more likely caused by GERD or related to chronic Helicobacter pylori infection is dealt with next, also taking into consideration recent experience with cytokeratin immunohistochemical stains. The following paper indicates that a short course of high-dose proton pump inhibitors is both accurate and cost-effective in identifying noncardiac chest pain secondary to GERD and may also be beneficial in patients with traditional reflux symptoms or GERD-related cough. The controversies in Barrett's esophagus as related to GERD are dealt with in the next article.