Persistent symptoms of GERD, especially occurring more often than 2 times a week for a longer time, require treatment. Based on symptoms, your physician may recommend lifestyle changes such as smoking cessation, avoiding certain foods, losing weight if necessary, and eating not later than 3 hours before going to sleep or lying down. Also, he or she may start you on over-the-counter antacids or a medication that diminishes production of acid in the stomach, such as H2 receptor antagonists or proton pump inhibitors. If the symptoms persist, additional diagnostic procedures include upper endoscopy (examination of the esophagus and stomach through a flexible tube with a camera) or barium (radiological contrast) swallow test. In some cases it may be necessary to do a pH-monitoring test (for stomach acidity) and manometry test (to measure the strength of the esophageal sphincter). Both of these tests involve passing a tube up the nose and down the throat to the end of the esophagus. These tests can confirm GERD and suggest the necessity of additional medical or surgical treatment.