Randomized EsophyX Versus Sham / Placebo Controlled TIF Trial: The RESPECT Study

Inclusion Criteria: * Age 18-80 years * Dependent upon daily PPIs for \> 6 months * Troublesome symptoms, specifically heartburn or regurgitation, while on 40 mg of omeprazole or equivalent. Troublesome heartburn or regurgitation symptoms are those which occur a minimum of 2-3 days a week and are at least moderate in severity. * Abnormal ambulatory pH study off PPI therapy for 7 days. * Normal or near normal esophageal motility (by manometry) * Hiatal hernia axial height is no larger than 2 cm and the transverse dimension should not exceed 2.5 cm * Patient willing to cooperate with post-operative dietary recommendations and assessment tests * Signed informed consent Exclusion Criteria: * BMI \> 35 * Hiatal hernia \> 2 cm * Esophagitis Los Angeles grade C or D * Esophageal ulcer * Esophageal stricture * Esophageal motility disorder * Pregnancy or plans for pregnancy in the next 12 months (in females) * Immunosuppression * ASA \> 2 * Portal hypertension and/or varices * History of previous resective gastric or esophageal surgery, cervical spine fusion, Zenker's diverticulum, esophageal epiphrenic diverticulum, achalasia, scleroderma or dermatomyositis, eosinophilic esophagitis, or cirrhosis * Active gastro-duodenal ulcer disease * Gastric outlet obstruction or stenosis * Severe gastroparesis or delayed gastric emptying confirmed by solid-phase gastric emptying study if patient complains of postprandial satiety during assessment * Coagulation disorders * Interprocedural det…