The endpoints should be settled before the treatment of GERD. These are symptom relief, healing and maintenance of erosive or ulcerative lesions, and also probably prevention of several complications of GERD. In medical treatment for GERD, we can take some different strategies, that is, single-agent, step-up or step-down therapy. The authors reviewed the effects of many drugs, being used for GERD therapy, and decided the levels of therapeutic effects from the view point of EBM. Using these results, we recommended that the therapy of GERD should be started with PPI of a regular dose and stepped-down in usual cases, but it should be begun with PPI and stepped-up in refractory cases. PPI may be necessary also for maintenance treatment in most latter cases. The guideline of the treatment for GERD were discussed.