Symptomatic stricturing of the esophagus complicates the course of about 10% to 15% of patients with gastroesophageal reflux disease, particularly if they are elderly or if there is an associated Barrett's esophagus. Treatment goals include relief of symptoms of reflux disease and dysphagia, and prevention of their recurrence. The main therapeutic option to date has been endoscopic dilation. Although more than 30% of patients require serial long term dilations, this proportion can be minimized by the concomitant use of long term, high dose proton pump inhibition. Indications for surgery include failure of medical management. It is too early to assess the impact of laparoscopic technology on the treatment of peptic strictures. At this time, well designed prospective comparative trials are needed to quantify better the cost effectiveness of available treatment strategies in the management of patients with esophageal peptic strictures.