We have examined a consecutive series of patients referred to the Esophageal Clinic of the University of Illinois because of esophageal symptoms. Sixty-three patients were examined and contrasted with a series of 25 normal controls. Preoperative and postoperative symptoms were useless as factors for distinguishing whether a patient had reflux or spasm or both due to a wide overlap of symptomatology. Operation was performed on 22 patients. In ten with esophagitis alone, healing of the lesion and relief of symptoms resulted. In six with esophagitis and spasm, whereas healing occurred in all, in only two were symptoms relieved. Of six with spasm alone, only one experienced relief of symptoms.