Background: Gastroesophageal reflux disease (GERD) often presents with typical symptoms like heartburn and regurgitation; however, atypical presentations such as laryngitis, asthma, and chronic cough are less understood and pose diagnostic challenges.Methods: This prospective observational study at S STantia Medical College involved 100 patients over three months, utilizing endoscopy, 24-hour pH monitoring, and impedance/pH monitoring to diagnose GERD. Patients were treated with proton pump inhibitors (PPIs) and monitored for symptom improvement.Results: Diagnostic tests confirmed GERD in 60% of patients, with impedance/pH monitoring identifying additional cases of nonacid reflux. Treatment with PPIs led to significant symptom improvement in 70% of the participants. However, 30% exhibited persistent symptoms, suggesting alternative underlying causes or misdiagnosis.Conclusion: The study highlights the complexity of diagnosing and treating atypical GERD. The findings underscore the necessity for comprehensive diagnostic strategies and individualized treatment plans. The significant symptom resolution in most patients with PPI treatment confirms their efficacy, although the persistent symptoms in others call for further investigation into alternative diagnoses.