Abstract: Proximal gastrectomy, the surgical treatment of gastric upper adenocarcinoma or early esophagogastric junction adenocarcinoma, has received more and more attention. However, pathophysiological changes after proximal gastrectomy lead to a high risk of severe gastroesophageal reflux or reflux esophagitis, such as loss of mechanical anti-regurgitation barrier and receptive relaxation, decrease of peristalsis of remnant, incoordinate contraction, pylorus spasm, which limit its widespread use. Dozens of digestive tract reconstruction methods with different anti-reflux design have been reported in recent years. These strategies could be divided into 3 categories: buffer zone method, reconstruction of mechanical anti-regurgitation barrier, speeding up gastric emptying. The authors analyze the pathophysiological changes related with gastroesophageal reflux after proximal gastrectomy from the perspective of anatomy and phy-siology,summarize the advantages and disadvantages of anti-regurgitation methods, and look forward to the development trends in the future.