SUMMARYProton pump inhibitors, which act at the terminal point of acid secretion -the H + , K + -ATPase -are currently the most effective pharmacological treatments available for reflux disease. Despite the efficacy of the proton pump inhibitors, there is still potential for clinical improvement in gastro-oesophageal reflux disease pharmacotherapy. Faster onset of complete acid inhibition and improved duration of efficacy are two potential areas for improvement A number of novel pharmaceutical agents are currently undergoing clinical evaluation for the treatment of gastro-oesophageal reflux disease. These include transient lower oesophageal sphincter relaxation-reducing agents, serotonergic agents/prokinetics, potassium-competitive acid blockers, mucosal protectants, histamine H 3 agonists and anti-gastrin agents. One or more of these drug groups may represent the future medical therapy for gastrooesophageal reflux disease, should they prove effective in the clinical setting. This review summarizes the state of the art with these agents.