Digestion and food have been a theme of human interest for thousands of years starting with the Greeks who thought digestion was a process of heating food converted to a chyle and then to the four humors (blood, phlegm, yellow and black bile). In 1823 an English scholar presented a landmark paper at the Royal Society of London which said that it was hydrochloric acid which was present in the stomach. He also classified foods into fats, carbohydrates and proteins. Speaking at the Physician’s Update Conference in Cape Town during February 2018, Dr Levin begins his presentation by discussing what is normal. These include: the relaxation of lower oesophageal sphincter; transient lower oesophageal sphincter relaxation; oesophageal acid clearance by peristalsis; saliva to neutralise refluxed acid; post prandial pocket of acid. Crura of the diaphragm which can loosen with age and time and cause an hiatus hernia. The failure of anti-reflux mechanisms will cause reflux and all are worsened by weight gain. Prof Levin discusses theories about why reflux occurs in pregnancy. He provides information on the classification, i.e. GORD is a condition which develops when the reflux of stomach content causes troublesome symptoms and /or complications. Can be oesophageal or extra-oesophageal syndromes. Dr Levin presents images of erosive oesohagitis; Barrett’s oesophagus; oesophageal stricture with chronic erosive oesophagitis; and, oesophageal adenocarcinoma with Barret’s oesophagus. He discusses typical symptoms, and what the physician should be asking; atypical symptoms; and, alarm symptoms. He discusses who to test and who to treat. Levin presents information on treatment, including lifestyle modification which includes weight loss, raising head of bed, avoiding late meals and avoiding foods which are enemies of the sphincter, such as Coca Cola. He adds that it is important for patients to go to sleep. Levin also provides information on treatment medicines and looks at the proton pump inhibitor as a treatment and its efficacy. He discusses treatment during pregnancy. Dr Levin explores the various endoscopic therapies, such as, magnetic sphincter augmentation; electrical stimulation; radiofrequency energy (Stretta procedure); and the transoral incisionless fundoplication device. He concludes by summing up practice points.