Background: There is scarce data from India on symptom correlation in patients undergoing ambulatory 24-hour pH monitoring. Aim: Retrospective analysis of symptom correlation in patients undergoing ambulatory 24-hour pH study at our center. Material and methods: The study included patients who had 24-hour pH testing from 2015 to 2017 for typical or extra-esophageal symptoms of gastroesophageal reflux disease (GERD). Patient information included age, gender and indications for the pH study. Collected data included reflux details in upright and recumbent position, correlation with meals, duration and number of reflux events, Johnson/DeMeester score, symptom index (SI) and symptom sensitivity index (SSI). Descriptive analysis was carried out by median and range for quantitative variables, and frequency and proportion for categorical variables. Chi-square tests and Mann-Whitney U test were used. P value <0.05 was considered statistically significant. Results: Thirty-six of the 66 patients had Johnson/DeMeester score >14.7 (Group 1). Heartburn, regurgitation and extra-esophageal symptoms were significantly more common in Group 1. These patients also had significantly more reflux in both upright and supine position, with significant reflux episodes in both positions. They also had more reflux episodes lasting for more than 5 minutes. Post meal reflux episodes were common. SI was significantly high in Group 1. The positive symptom correlation, as assessed by SI >50% and SSI >10%, was higher for heartburn, regurgitation compared to chest pain and extra-esophageal symptoms, although not statistically significant. Conclusion: About 45% of patients undergoing pH study had no pathological reflux. 24-hour pH study is useful to identify pathological acid exposure with good symptom correlation for typical as well as extra-esophageal symptoms.