“Reflux esophagitis does not take a man’s life, but it is enough to ruin his life”. This is the classic description of GERD by DeMeester, a leading American surgical expert in GERD. However, as we continue to learn more about GERD, we are coming to realize that this passage is actually way off. One important factor in GERD being a potentially lethal disease is its close relationship with pancreatic cancer. We know that the cardia is the connection between the stomach and esophagus, and in the past the incidence of cardia cancer was much lower compared to sinus cancer, which is highly prevalent in our country. However, in recent years, the incidence of pancreatic cancer has been increasing, and in the United States, its incidence has increased as much as seven times in the last decade or so, and has approached the incidence of gastric sinus cancer. Cardia cancer is actually not just stomach cancer, but a significant portion of it is actually adenocarcinoma of the lower esophagus. GERD is a major factor in the increasing incidence of pancreatic cancer, which requires more invasive surgery than sinus cancer. The esophageal mucosa of GERD patients is chronically stimulated by gastric contents such as refluxed gastric acid and bile, and the esophageal mucosa is much more fragile to these stimuli than the gastric mucosa. The long-term chronic irritation leads to inflammation of the esophageal mucosa, which further develops into Barret’s esophagus, a precancerous lesion of esophageal adenocarcinoma, and its cancer risk is 60-100 times higher than that of normal people. During this development process, patients often also have only general symptoms of GERD without obvious symptomatic changes, so it is easy to be ignored by patients, especially those who have been taking acid suppressants for a long time and are effectively treated. Foreign studies have found that certain specific GERD patients are at higher risk of developing Barret’s esophagus than the average patient, including younger patients, frequent symptom episodes, and long-term treatment with medications such as acid reducers. The current main treatments for GERD are conservative treatment and surgery. The former is mainly to control the symptoms by taking medications such as acidulants, and is the treatment option of choice for most patients. Unfortunately, however, drugs can only reduce the acidity of the refluxed material, but not the reflux, and thus cannot completely avoid damage to the esophageal mucosa, especially when accompanied by non-acid reflux such as bile reflux. A large number of foreign studies have shown that the use of acid suppressants, while controlling symptoms and improving quality of life, cannot prevent the development of Barret’s esophagus, and thus cannot control the potential malignant possibility. Once the disease has progressed to Barret’s esophagus, either medication or anti-reflux surgery can only control the symptoms but not prevent malignancy, unless lower esophagectomy is performed. Anti-reflux surgery is the only treatment that can cure GERD, which can eliminate GERD at the root and therefore has better long-term efficacy than medication, especially in stopping disease progression and preventing cancer. Given that once the disease has progressed to Barret’s esophagus, even anti-reflux surgery is not enough, surgical eradication should be performed before the disease progresses to this stage, especially for the specific patients mentioned earlier.