We reviewed the histopathological features for the diagnosis of gastroesophageal reflux disease (GERD). The presence of infiltration inflammatory cells, thickened basal cell layer, increased papillary height was histopathologically evaluated in GERD patients. It is often difficult to diagnose GERD symptoms when there were few endoscopic findings, such as lack of hiatal hernia and erosive esophagitis. At that time, we might be able to diagnose GERD by the histopathological examination except the pH monitor was performed. We showed that the histopathological esophagitis correlated with reflux symptoms and laryngopharyngeal symptoms. These indicated that the histopathological esophagitis may be diagnosed as not only typical GERD but also atypical GERD.