The GI specialist has an important role to play in the long-term management of gastroesophageal reflux disease (GERD) patients; to secure a proper diagnosis and the selection of best possible therapeutic strategy. Through intensified information and education the implementation of national and international guidelines can be more effectively processed, whereupon a significant improvements in also cost-effectiveness of the current management will be fostered. Regarding the more specific group of GERD patients, as represented by the so called PPI refractory patients, data have now emerged to guide us into the future. Noteworthy is that the majority of the alleged PPI-refractory GERD patients do not, after careful investigations, have GERD. Based on recently published RCT data a clinically highly relevant difference in treatment success was noted in favor of laparoscopic antireflux surgery as compared to a variety of medical treatment alternatives. Likewise it can be concluded that it seems as if the latter can only offer a limited effect. Whenever a corresponding powerful clinical difference in therapeutic outcome between different strategies-treatment alternatives is detected, this will have a huge impact on treatment algorithms and clinical management.