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One of the challenges to the effective management of gastroesophageal reflux disease (GERD) is the multiple pathophysiological etiologies that contribute to this symptom complex. The majority of patients with GERD have no visible abnormalities during standard endoscopic examination, and this subgroup of patients, defined as having non-erosive reflux disease (NERD), has a low response rate to acid suppression therapy with proton pump inhibitors. With advances in endoscopic imaging technology, it may soon be possible to better define subtle esophagus lesions in these patients, which may help identify those that will respond to acid suppressive therapy. In order for these technologies to have a role in the evaluation and management of patients with GERD, several criteria must be met. To date, electronic chromoendoscopy and confocal laser endomicroscopy appear to hold the most promise based on the existing data and reproducibility of the identified esophageal abnormalities. However, there continues to be a need for high-quality research, as not a single imaging technology has been shown to predict therapeutic response rates in NERD patients.