The first step in managing esophageal reflux disease involves medical treatment. Lifestyle changes (diet, smoking cessation, sleeping position) should always be the first step. Antacid medications can neutralize acid that refluxes into the esophagus and prevent damage to the esophagus. More effective medications can sharply reduce the production of acid. If these medications do not eliminate symptoms, surgery may be necessary. The primary surgical treatment of esophageal reflux is called esophageal fundoplication. Fundoplication can be performed through an upper midline incision or using a laparoscopic procedure.