Gastroesophageal reflux disease (GERD) is commonly reported on esophagram (UGI) studies. The correlation of findings suggestive of GERD on UGI with pH monitoring and high-resolution esophageal manometry (HRM) studies is unclear. We investigate the correlation between reflux on UGI with the findings on pH studies and HRM. Subjects completed a symptom questionnaire before their scheduled study. Data from pH and HRM studies were compared with findings of the UGI. Sixty-five patients were evaluated. Reflux was reported on UGI in 19 of 65 (29.2%). Thirty-six patients had both UGI and pH studies; 22 of 36 (61.1%) had reflux on pH studies. UGI had a false-negative finding in 11 of 20 (55%) with no radiographic evidence of reflux. There was a false-positive finding in five of 16 (31.2%) patients on UGI. There was concordance in 11 of 36 (30.5%). Sixty-three patients had both UGI and HRM; there was positive concordance in eight of 63 (12.7%). Using pH monitoring as the gold standard for GERD, sensitivity was 0.50, specificity 0.64, positive predictive value 0.68, and negative predictive value 0.45 for reflux on UGI. The correlation between reflux reported on UGI and 24-hour pH monitoring is poor. Esophagram (UGI) should be reserved for defining structural defects in the esophagus and not reflux.