Gastroesophageal reflux disease (GERD) is a common disorder that affects all segments of the population. These guidelines have been prepared to suggest the preferable, but not only, approaches to the management of a patient with GERD. The physician must be free to choose the course best suited to the individual patient. The world literature was reviewed and the guidelines were developed under the auspices of the American College of Gastroenterology, and approved by other gastroenterology societies. Diagnostic recommendations include the following: (1) general approach to GERD, including empiric therapy, (2) appropriate mucosal evaluation (ie, endoscopy and radiology), (3) use of pH and provocative testing, and (4) indications for manometric evaluation. Therapeutic recommendations include the following: (1) general approach to therapy including lifestyle changes, (2) use of acid suppression, (3) use of promotility drugs, (4) maintenance treatment of GERD, and (5) indications for antireflux surgery.