Peptic oesophageal stricture develops in approximately 10-15% of patients with inadequately treated reflux oesophagitis and poses a difficult clinical problem. The management of reflux oesophagitis has been revolutionised by improvements in medical management, endoscopic and balloon techniques of oesophageal dilatation. The major advance has been the development of inhibitors of gastric acid secretion: histamine receptor antagonists and H(+) + K(+) + ATPase inhibitors. Studies have recently shown that the H(+) + K(+) + ATPase inhibitor omeprazole is effective in the management of severe resistant reflux disease with peptic stricture formation, leading to a reduction in the number of oesophageal dilatations required by up to 60% of patients. The aim of this article is to review the current medical, endoscopic and surgical management of severe peptide oesophagitis with stricture formation.