Gastroesophageal reflux disease (GERD) is a highly prevalent complex chronic condition. The most extensive prospective and multicenter cohort study conducted in Europe has estimated that one-third of the patients with GERD may exhibit extra-esophageal symptoms. The Montreal Consensus recognized chronic cough, chronic laryngitis, bronchial asthma and tooth erosions as extra-digestive manifestations of GERD. The experts also considered that manifestations such as recurrent otitis media, idiopathic pulmonary fibrosis, sinusitis or pharyngitis are likely to be associated with GERD. The traditional techniques used in the diagnosis of typical GERD are less useful for the diagnosis of extra-digestive GERD. No single testing methodology exists to definitively identify reflux as the etiology for the suspected extra-esophageal symptoms. The PPI trial is the first diagnostic but also a therapeutic step, while evaluation through esophageal impedance-pH monitoring currently represents the goldstandard for diagnosis. Despite extensive work, extra-digestive GERD remains incompletely understood.