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The incidence of hiatal hernia increases with aging. When esophagitis occurs in the susceptible esophageal mucosa, it is probably the result of degenerative changes in the supporting tissues (collagen-elastin) and a diminution in cellular replication. The authors' concepts of the etiology of reflux esophagitis are described. Severe complications are not uncommon. In most patients, there is a good response to postural, dietary and antacid therapy, not only during the initial episode but during recurrence and in complicated cases. No surgical procedure has general acceptance. In the elderly patient, morbidity and mortality are of such significance that the benefits must be measured carefully against the disadvantages. Most operations are designed to correct a hiatal hernia and to enhance sphincteric competency. The complication, esophagitis, is a medical problem unless a concomitant disorder refractory to medical management requires operative intervention. The presence of hiatal hernia usually is a coincidence. The authors have found an antacid-combination (Gaviscon) treatment of reflux esophagitis.