Despite life style changes and compliant therapy with PPI, a large number of patients may have persistent symptoms and classified to have refractory GERD, a distinctive group that is difficult to manage (14). The putative reasons remain poorly defined but likely include contributions from factors such as non-acid reflux, visceral hypersensitivity, and abnormal esophageal motor events (14). A study by Tack et al investigated mechanisms for poor response to PPI therapy and showed persistence of acid reflux in 11%, bile reflux alone in 38% and a combination of acid and bile reflux in 26%. However, persistence of acid or bile reflux does not prove a causal relationship with symptoms (15). Also, in this group of individuals with acid or bile reflux on BID PPI's, a possible treatment option is Nissen's fundoplication, the utility of which is yet to be proven in this cohort. There is no consensus definition of refractory GERD and generally, it is defined as non-response of symptoms to optimum PPI trial. The goal of providing symptomatic relief to these refractory patients is extremely challenging in view of limited options. It is to these patients that the investigators would like to evaluate in a feasibility study the use of complementary medicine modalities including acupuncture and yoga that may be relatively safe, cost-effective therapies to help with the distressing symptoms of GERD.