An understanding of the natural history of GERD has an important impact on the long-term management of the disorder. By assessing the currently available studies that evaluated the natural course of GERD, a new conceptual framework that suggests that GERD is composed of three distinct phenotypic presentations has been recently proposed. Presently, the field has been divided into two camps that support or oppose a paradigm shift in the natural course of GERD. Nevertheless, the largest population-based or longest duration natural course studies report only 10% progress from NERD to erosive esophagitis over time. The other GERD patients remained within their respective phenotypic presentation of GERD.