Endoscopy shows a red, streaky erosion at the end of the esophagus! This is already a grade D esophagitis, which is more severe. The pancreatic opening can also be seen to be significantly flaccid. Under normal circumstances the cardia is tightly wrapped around the black body of the gastroscope. This patient has a history of 20 years and has taken many medications intermittently, but also repeatedly. He finally came to us. This patient was prepared for repair of the fissure and fundoplication to address the root of the reflux problem. This is the reason why the medication is not working well is because the cardia is not functioning well and the stomach door is not closing.