BACKGROUND The gag reflex is a protective response that prevents foreign objects or noxious material from entering the pharynx, larynx, or trachea; it is not elicited during a normal swallow. Although no data have been reported to support a relationship between the gag reflex and dysphagia, the gag reflex is nevertheless routinely assessed during the bedside dysphagia evaluation. The purpose of the present study was to investigate whether absence of a gag reflex is a predictor of dysphagia. METHODS Fourteen consecutive adult subjects referred for a bedside dysphagia evaluation because they were considered to be at increased risk for aspiration, specifically due to absence of a gag reflex, were investigated. In addition, the gag reflex was assessed in 69 normal adult volunteers. RESULTS Although all subjects were referred for bedside dysphagia evaluations specifically because they had no gag reflex, 86% (12/14) were nevertheless able to eat at least a puree diet. In addition, 86% (12/14) of subjects with no gag reflex had normal velar movement, reinforcing the physiologic differences between velar functioning during phonation and the gag reflex. The gag reflex, traditionally considered part of the bedside dysphagia evaluation, was absent in 13% (9/69) of nondysphagic subjects, raising further doubts regarding its clinical relevancy. CONCLUSIONS The absence of a gag reflex does not appear to be a predictor of dysphagia.