Endoscopy is not mandatory for every reflux complaint. In patients with typical symptoms and no alarm features, clinicians often start with lifestyle optimization and a short therapeutic trial while monitoring response. However, endoscopy becomes important when alarm signs are present (difficulty swallowing, bleeding, weight loss, anemia, persistent vomiting), when symptoms are long-standing and treatment-resistant, or when complications are suspected. Endoscopy helps detect esophagitis, strictures, Barrett’s esophagus, and can rule out alternative diagnoses. Even if endoscopy is not immediately required, high-frequency or sleep-disrupting symptoms still warrant professional planning. The objective is not over-testing, but accurate confirmation in the right patient.