A.D. is a 25 year old patient who has severe daily heartburn for last 2 years. He takes OTC antacids for relief. Recently, he has developed difficult and painful swallowing. He underwent an upper endoscopy which revealed multiple ulcers in the esophagus(food pipe). The endoscopic image is illustrated above. He was treated with proton Pump Inhibitor(PPI) therapy for 2 months and he achieved not only complete relief of his symptoms but also complete healing of his esophageal ulcers. He is now taking a maintenance dose of the medication once daily. Proton pump inhibitors are a potent class of medications which are very effective in achieving near complete gastric acid supression. This makes them very effective in managing a variety of upper gastro intestinal illness which are caused or exacerbated by gastric acid. These include esophageal, gastric and duodenal ulcers. Untreated, severe ulcerations in the esophagus may lead to stricture(narrowing) in the esophagus which will cause trouble in swallowing solid foods and can also predispose to the formation of an abnormal lining of the esophagus called Barrett's esophagus which can ultimately lead to esophageal cancer in some patients. Although, recently we have also become acutely aware of long term side effects of these medications, by and large in most patients with above illnesses, the benefits outweigh the risks of taking these medications.