In summarizing the evolving relationship of GER and pulmonary disease, one cannot ignore the potential role of reflux in patients with recurrent pneumonia or atypical asthma. Infants with vomiting, failure to thrive, and wheezing, and patients with recurrent pulmonary infiltrates, spasmodic nocturnal cough, and choking should have an evaluation of esophageal function with attention to GER. Trie need to investigate GER in the wheezing patient who has a history of episodic difficulty related to specific inciting factors such as allergens and viral syndromes, or in the chronic asthmatic who is free of gastrointestinal complaints and rarely has nocturnal coughing or pneumonitis, is doubtful. If one finds that GER exists, one needs to understand that it may not be causing disease but may be coincidental or possibly caused by pharmacologic therapy. If GER is found, medical therapy should precede surgical intervention.