I have a lazy LES too. Doctors can tell from an endoscopy if they do the manometry testing during the endoscopy, which is what mine did. He put me on reglan to force my LES to contract, but that is only a bandaid approach. You can't take reglan for long periods of time (it does work by the way). Christo is right, I'm afraid, that surgery is the only semi-permanent fix. However, if you take the PPIs, you will still experience the reflux, but the acid will be better controlled. This has worked for me for a number of years now, except that eventually I started developing erosions again from acid (presumably). If I fail another PPI (I've been on aciphex for 5 years now and developed erosive gastritis anyway), I may talk about the surgery. But I understand the surgery can cause other problems, and many times the patient has to start acid meds again after about 5 years. I'm not sure I'm ready to jump on the surgery bandwagon just yet.
Current dx: Rheumatoid Arthritis
Suspected dx: UCTD/Early Lupus
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan