This study reports the results of 26 patients with documented reflux esophagitis treated with the Nissen fundoplication procedure after failing a conservative therapy trial. In all patients in which the plication remained intact (96%), reflux was prevented and esophagitis healed. In five of the 26 patients, symptoms persisted despite the abatement of reflux and resolution of the esophagitis. This was determined to be on the basis of persistent esophageal spasm unrelated to the reflux esophagitis. The mean resting lower esophageal sphincter (LES) pressure was significantly diminished from normal in 11 patients failing conservative therapy. This was increased postoperatively, approaching normal. The initial mean resting LES pressure in eight patients responding to medical nonoperative therapy was not significantly different from normal. After therapy, there was no significant rise in the mean LES pressure. This is interpreted to mean that it is probably possible to identify those patients with reflux esophagitis who will respond to conservative management.