Abstract: Objective: To study esophageal motility and acid exposure in patients with gastroesophageal reflux disease(GERD) with different Traditional Chinese Medicine(TCM) syndromes. Methods: One hundred and eighty-nine patients with typical reflux symptoms were selected from April 2015 to December 2019, divided into five types according to the TCM syndromes:stagnation of heat in liver and stomach, stagnation of heat in gallbladder and stomach, stagnation of Qi and phlegm, middle deficiency and Qi inversion, spleen deficiency and dampness heat. At the same time, gastroscopy, high resolution esophageal manometry(HRM), 24 h multi-channel impedance combined with pH monitoring were completed. The relevant data were recorded, and the differences of esophageal motility and pH impedance between different syndromes were compared. SPSS 16.0 software was used for statistical analysis. Results: In the aspect of esophageal motility:upper esophageal sphincter pressure(UESP) comparison:UESP was the lowest in stagnation of Qi and phlegm syndrome; distal contractile integral(DCI) score,ineffective esophagus motility(IEM) cases, percentage of weak peristalsis and loss of peristalsis:the DCI score was lower than other syndrome groups in stagnation of heat in liver and stomach syndrome and stagnation of heat in gallbladder and stomach syndrome. The number of IEM cases, percentage of weak peristalsis and loss of peristalsis were higher than other syndrome groups(P<0.05); Comparison of distal latency(DL) and esophagogastric junction(EGJ) typing:no significant difference between the two groups(P>0.05); Lower esophageal sphincter pressure(LESP) comparison:the lowest LESP was in the syndrome of middle deficiency and Qi inversion, followed by the syndrome of spleen deficiency and dampness heat. In terms of acid exposure:the demeester score, total reflux time, total reflux times, acid exposure time(AET), standing AET% and decubitus AET% in spleen deficiency and dampness heat syndrome were higher than those of in other syndrome groups(P<0.05); The demeester score, total reflux time, total AET% and standing AET% in stagnation of heat in liver and stomach syndrome and stagnation of heat in gallbladder and stomach syndrome were higher than those of in middle deficiency and Qi inversion syndrome(P<0.05); Compared with other syndrome groups, the total amount of proximal esophageal reflux, acid reflux and weak acid reflux of proximal esophagus were all higher stagnation of Qi and phlegm syndrome(P<0.05). Conclusion: There are significant differences in esophageal dynamic indexes among GERD patients with different TCM syndromes. The upper esophageal sphincter barrier function is decreased more in stagnation of Qi and phlegm syndrome, the esophageal body peristalsis dysfunction is more common in liver stomach heat stagnation syndrome and gallbladder stomach heat stagnation syndrome, and the anti-reflux barrier function of EGJ is decreased more in middle deficiency and Qi inversion syndrome, and spleen deficiency and dampness heat syndrome. In terms of acid exposure, the index scores of acid exposure of spleen deficiency and dampness heat syndrome were higher. The index scores of stagnation of Qi and phlegm syndrome in acid exposure of proximal esophagus were higher. There is a certain correlation between TCM syndromes of gastroesophageal reflux disease and esophageal motility and acid exposure.