Introduction: Gastroesophageal reflux symptoms, as measured in a self-reported GERD questionnaire (GERDQ) do not always correspond to true gastroesophageal reflux disease (GERD). The 24-hour esophageal pH monitoring remains the objective gold standard for diagnosing true GERD.Hypothesis: We hypothesized that specific component questions of GERDQ were clinically associated with two key summary measures of the 24-hour esophageal pH monitoring: distal time (DT; % total time pH <4 in the esophagus) and Demeester score (DS; a formal weighting scale based on the esophageal pH measurements). Methods: 315 consecutive, unselected individuals with GERD-like symptoms from the community were referred for the 24-hour esophageal pH monitoring. Participants completed a baseline GERDQ. Univariate analyses identified subset questions of GERDQ most associated with DT/DS. Multivariate analysis of this subset identified questions that independently predicted for GERD. Result: 280 (89%) individuals had complete questionnaire and covariate data: 62% were female and the median (range) age of the candidate pool was 47.3 (18-84) years. 48% had onset of heartburn > 5 years; 51% reported heartburn to be severe or very severe. 51% were found to have true GERD on the basis of having either DT > 4% or DS > 14.7. Males were more likely to have true GERD (Chi-squared p=0.04); age was not associated with GERD (p=0.11). Univariate logistic regression identified 10/22 key GERD questions that were significantly associated with DT/DS. In multivariate analyses, only two questions (“Has acid regurgitation awakened you at night?” and “Have you ever had esophageal or gastric disease?”) remained significant; the c-statistic was 0.60 for DT/DS. An expanded analysis incorporated three additional clinically important GERD questions to the model (“How many years since your first onset of symptoms?”, “Has heartburn awakened you at night?”, and “What gender are you?”), and a scoring system was developed. 100% of individuals scoring ≥7 on an 8-point scale had true GERD; specificity and sensitivity for DT/DS were 100% and 14.0%, respectively. Sensitivity for any of these combinations of questions never reached above 70%.Conclusion: No single or combination of components of GERDQ was sensitive enough to rule out patients for esophageal pH monitoring. Though a five-question short questionnaire may be useful for predicting a small subset of patients who have a very high chance of having true GERD, subjective questionnaire information was not useful in predicting which patients did not have GERD.