inhibition [111]. It seems a good medical practice to screen and treat the elderly for osteoporosis irrespective of PPI use [49]. To summarize the available risk/benefit data on PPIs, PPIs should be used for appropriate indications and should not be used in higher doses longer necessary to achieve the desired outcome. 5.2. Surgery for GERD 5.2.1. Open Antireflux Surgery. Antireflux surgery has devel- oped only after it was documented in the 1950s that a hiatal hernia was associated with GERD [112]. At the beginning, when hiatal hernia was considered the major factor in the production of GERD, antireflux surgery was performed to reduce the hiatal hernia and keep the LES within the peritoneal cavity [113]. Later, when low LES pressure