This report examines alternatives for managing the chronic symptoms of uncomplicated gastroesophageal reflux disease (GERD) in patients who may require long-term treatment. It summarizes the available evidence comparing the efficacy and safety of medical, surgical, and endoscopic interventions in the treatment of chronic GERD, particularly after long-term followup. Questions addressed in this report are: 1) What is the evidence of the comparative effectiveness of medical, surgical, and endoscopic treatments for improving objective and subjective outcomes in patients with chronic GERD? 2) Is there evidence that effectiveness of medical, surgical, and endoscopic treatments varies for specific patient subgroups? 3) What are the short- and long-term adverse effects associated with specific medical, surgical, and endoscopic therapies for GERD?