Endoscopic Fundoplication Versus Proton Pump Inhibitors for GERD Treatment

Inclusion Criteria: * Age 18-75 years * Proven gastroesophageal reflux (pH \< 4 for \> 4.3% time while off PPIs for 7-14 days) * On daily PPIs for \> 1 year * Recurrence of GERD symptoms (GERD-HRQL score difference of \> 10 between on and off PPIs) * Normal or hypotonic LES resting pressure (5-40 mmHg) * Patient willingness to cooperate with random group assignment, attend 4-5 office visits and comply with all tests in this protocol * Signed informed consent Exclusion Criteria: * BMI \> 35 * Hiatal hernia \> 2 cm * Esophagitis grade D * Barrett's esophagus * Esophageal stricture * Esophageal ulcer * Esophageal motility disorder * Gastric motility disorder * Prior splenectomy * Gastric paralysis * Pregnancy (in females) * Immunosuppression * ASA \> 2 * Portal hypertension * Coagulation disorders * Previous antireflux procedure * Any other health condition, which the investigator believes would prevent the patient from completing the study * Lack of fluency in English