Patients referred for surgical evaluation will occasionally experience dysphagia related to their GERD.In this patient population, the most common cause is esopha­geal mucosal inammation and damage. The inammatory changes can manifest as diffuse esophageal inammation, a Schatzki ring or a peptic stricture. Although the incidence of peptic strictures has signicantly decreased in the age of PPI therapy, they are considered pathognomonic for long-standing reux. If found on upper endoscopy, peptic strictures should always be biopsied to rule out intestinal meta­plasia, dysplasia or malignancy. Similarly to peptic strictures, Schatzki rings also arise in the distal esophagus. They can be differentiated on endoscopy by the appear­ance of submucosal brotic bands as opposed to the mucosal scarring seen in peptic stricture disease. Both should be dilated to relieve obstruction but Schatzki rings do not need to be biopsied unless there is a visible mucosal abnormality. Some patients with dysphagia in the setting of GERD have no identiable anatomic etiology. In these cases the dysphagia usually resolves with control of reux. Patients who pres­ent with sudden dysphagia to solids and liquids without anatomic abnormalities should be evaluated for neuromuscular or autoimmune disorders.