Substernal pain, especially in the recumbent position, difficulty in swallowing, and recurrent bouts of aspiration pneumonia are commonly associated with roentgenologic evidence of gastroesophageal reflux. Esophagoscopy with manometric studies and intraluminal pH measurements are indicated. The latter studies may be extended over a 24-hour period of observation. Barium studies of the entire gastrointestinal tract may demonstrate a duodenal ulcer or other disorders. A gastric analysis, as well as serum gastrin determinations, should be made. Antacid therapy, elevation of the head of the bed, and effective weight reduction in obese patients may decrease the severity of symptoms.