There are several available diagnostic options to evaluate patients with suspected gastroesophageal reflux, whether acid, weakly acid, or nonacid. The appropriate application of these technologies is the subject of much discussion among experts. Thoughtful use of reflux monitoring is of great benefit in the evaluation of patients with endoscopy-negative disease reflux symptoms that are resistant, recurrent, or refractory to standard or double-dose antisecretory therapy; patients with distinct, atypical symptoms such as cough, laryngitis, chest pain, globus, or regurgitation in whom heartburn is infrequent or absent; patients who are seeking surgical or endoscopic corrective procedures to treat their symptoms; and those with recurrence of symptoms after undergoing surgical procedures. Reflux monitoring may be useful in avoiding an incorrect diagnosis of gastroesophageal reflux disease (GERD) and in management of patients with Barrett's esophagus. This article will review the current clinical applications of reflux monitoring in patients with GERD.