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There is a growing body of work showing the clinical applications of MII–pH monitoring both in pediatric and adult patients, the details of which are discussed in Chapter 19. In short, with its ability to measure not only acid but also nonacid reflux, MII–pH monitoring shifts the GER testing paradigm: reflux events are no longer detected by pH alone. Instead, the presence, distribution, and clearing of refluxate is primarily detected by MII, and characterized as acid versus nonacid based on pH change and as liquid, gas, or mixed based on MII. Because of its enhanced ability to detect and characterize GER, MII–pH has evolved into a clinically useful tool, especially for the evaluation of persistent symptoms despite acid suppression, an increasingly frequent clinical problem.