Gastroesophageal reflux is the commonest esophageal cause of chronic intermittent aspiration. The authors investigated 1000 consecutive patients with reflux with reference to their medical history, and by barium esophagography, esophageal manometry and pH studies. In patients with respiratory complications, chest roentgenography and pulmonary function tests were also performed. Of the total number, 279 patients aspirated either by coughing and choking during swallowing or as a result of night reflux; of these, 159 had associated respiratory symptoms, which included cough, voice change, recurrent respiratory infection, bronchiectasis and asthma. Of the patients with aspiration, 120 had surgical correction of reflux because conservative management failed. This form of reflux control improved the symptoms of cough and voice change and the condition of patients with recurrent infections or bronchiectasis, but alleviated the symptoms in only 8 of 28 asthmatic persons.