Most reflux is mild and managed with lifestyle modification and PPIs (proton pump inhibitors). A subset of patients have severe reflux requiring lifelong medication, intolerable side effects, or progress to oesophagitis, stricture, or Barrett's oesophagus. Surgical anti-reflux therapy (Nissen or Toupet fundoplication, with hiatus hernia repair where present) is curative for around 85 percent of these patients at ten years.