Gastroesophageal reflux disease (GERD) is one of the most common ailments that can decrease quality of life to below that of patients with congestive heart failure. Patients can present with typical, atypical, or serious symptoms, either alone or in combination. History, esophagogastroduodenoscopy, and 24-hour pH monitoring can help with the diagnosis; but all are not needed for each patient. This clinical review will help primary care physicians to make a rapid diagnosis, guide subsequent treatment, and indicate when to order additional testing or referral, or both.