Reflux-like symptoms are common; however, not always due to gastro-esophageal reflux disease (GERD) and thus objective testing for GERD is critical, particularly prior to long-term or invasive therapy. In the absence of Los Angeles Grades B, C, or D esophagitis on upper endoscopy, ambulatory reflux monitoring off antisecretory therapy with either a 96-h prolonged wireless reflux monitoring or 24-h pH-impedance is recommended. Mucosal impedance testing is an emerging adjunct technology to assess esophageal mucosal integrity. These testing modalities can help establish the presence or absence of proven GERD, and ultimately guide antireflux-targeted treatments.