Objective To analyze 24 h esophageal pH-impedance and high-resolution manometry for the patients with refractory gastroesophageal reflux disease, and provide evidence for the clinical diagnosis, treatment and nursing of these patients.Methods 24 h esophageal pH-impedance and high resolution manometry were measured and corresponding nursing measures were applied for the patients with refractory gastroesophageal reflux symptoms.Results A total of 115 in 118 patients successfully completed the examination with a success rate of 97.4%, and 90 (78.3%) of which showed abnormal in 24 h esophageal pH-impedance examination. High-resolution manometry showed that 83 patients (72.2%) had esophageal motility disorder.Conclusions Most patients with refractory gastroesophageal reflux disease have abnormal reflux and esophageal motility disorder. Skilled operative technique, detailed and comprehensive nursing are the guarantee to accomplish the examination.