**Abstract**

Esophagitis is a debilitating disease often leading to more serious conditions. It is aggravated by refluxed stomach acids for which the usual treatment is PPI drugs that at best treat the symptoms, not the underlying cause of reflux. Surgical interventions address the root - Hiatal muscular incompetence - but are invasive and expensive. Both treatments have proven unwanted side-effects. Neuromuscular treatment is a new and innovative alternative that addresses the root cause of reflux. The science and evidence behind this treatment is presented here. Reflux cannot happen when the diaphragm functions properly and maintains adequate pressure in the Hiatal canal, otherwise the neck of the stomach can intrude through the diaphragm into the chest cavity allowing reflux and conditions such as GERD, LPR, silent reflux, dyspepsia and more. This is especially common at night, when in bed. Training with a simple and inexpensive neuromuscular medical device takes 90 seconds per day, self-administered by the patient without medication or surgical intervention. No negative side effects are recorded for this treatment. Currently, 40 000 individuals have treated with the device. It is deployed in healthcare institutions in several countries and is recognised in the UK by NICE in a briefing to the NHS as a treatment for Hiatal hernia.

**Keywords:** dysphagia, esophagitis, GERD, hiatal hernia, hiatal incompetence, manometry, neuromuscular treatment, obesity, PPI medication, reflux
