Gastroesophageal reflux disease (GERD) is a common problem that occurs in both adult and pediatric populations and can significantly degrade patients' quality of life and lead to life-threatening complications. A prudent course of management in a patient with classic GERD symptoms would be to empirically prescribe lifestyle modifications and a proton pump inhibitor (PPI) for six to eight weeks. Osteopathic manipulative treatment may also be a useful adjunct. If the patient is unable to afford a PPI, a histamine type-2 receptor antagonist may be substituted (although they are much less effective). If resolution of symptoms occurs, the therapeutic response can confirm the diagnosis of uncomplicated GERD. If the patient has recurrent or intractable symptoms, the next step would be to order pH monitoring, manometry, or endoscopic evaluation of the esophagus and stomach (esophagogastroduodenoscopy [EGD]). If there are any atypical symptoms such as persistent cough, asthma, melena, sore throat, or hoarse voice, EGD should be ordered immediately. Patients with chronic esophagitis or extra-esophageal symptoms who have failed (or refused) medical management should consider fundoplication.