**Abstract**

Acid suppressive therapy (AST) has been the primary mechanism to provide gastroesophageal reflux disease (GERD) symptomatic relief and prevent complications in many individuals with GERD. Many AST options exist, but proton pump inhibitors (PPIs) have developed popularity in symptomatic relief for refractory GERD patients. To help reduce persistent symptoms, the use of AST therapy optimization is imperative and involves timing doses appropriately and increasing the dose and dosing frequency. Recently, more data has become available regarding the safety profile of AST, specifically PPI use. This data has raised awareness about its potential for toxicity with longterm use. This chapter focuses on the pharmacological management of GERD with a focus on the current updates regarding AST safety and efficacy.

**Keywords:** histamine 2 receptor antagonists, proton pump inhibitors, acid suppressive therapy, antacids, GERD, gastroesophageal reflux disease
