In clinical work, there are often patients who have gastroscopy results out and see gastroscopy results suggesting that the cardia opening and closing is good and there is no flaccidity. Often this is when the patient thinks, the cardia is not flaccid, why would there be reflux symptoms. The cardia is not flaccid, there will be no reflux – this is a misconception of most patients. An important factor in GERD is the transient relaxation of the lower esophageal sphincter (LES) (TLESR). TLESR refers to the spontaneous relaxation of the LES under non-swallowing conditions, and its relaxation time is significantly longer than the relaxation time of the LES during swallowing. It is an important cause of both physiological GERD in normal subjects and the main cause of GERD in patients with normal lower esophageal sphincter pressure. So the absence of cardia orifice relaxation is not the same as the absence of reflux. Accordingly, we often say clinically that a flaccid cardia is just a greater chance of reflux and more prone to reflux. It is also an objective criterion for us to evaluate whether a patient needs surgery or not. Overall, the diagnosis of GERD should be specific, objective and requires a comprehensive diagnosis.