Is the best treatment management for reflux, or for GERD. We certainly know that in patients who initially present our first line of treatment is going to be lifestyle changes. Our second line of treatment is going to be manage it with pharmacology. Be that, something that reduces the acid, such as an antacid or TUMS. Be that, something like an acid blocker such as an H2 blocker or something like a Proton Pump Inhibitor (PPI), which also decrease the amount of acid. Any one of those three on the short term is recommended. And the FDA has only approved the Proton Pump Inhibitors (PPIs) for 36 months. And so, it really wasn't designed to be a long term solution. And, as studies have come out the longterm deleterious affects of the PPI chronic use are sometimes outweighing the benefit of the GERD. And, so, we encourage you to manage it and it's part of our algorithm for diagnosing it sometimes. If you have indescript symptoms that we're not real clear on, we put you on a medicine that decreases the acid and that improves your symptoms that is both diagnostic and therapeutic. It is designed for the short term not the long term. If you couple the medicine with lifestyle changes and are able to get off the medicine and maintain the lifestyle changes then the problem has been solved. If you persist and require longterm medication, it may be worth willing to investigate surgical options.