Objectives: The impact of ineffective esophageal motility (IEM) on gastroesophageal reflux disease (GERD) remains unknown, and abnormal esophageal motility often coexists with abnormal gastric motility. We aimed to investigate the role of IEM in GERD and its relationship with gastric electrical activity.Methods: Patients diagnosed as GERD based on GERD-questionnaire score ≥8 in our hospital from January 2020 to June 2022 were included. All patients underwent 24-h multichannel intraluminal impedance-pH monitoring, high-resolution manometry, and electrogastrogram and were categorized into the normal esophageal motility (NEM) and IEM groups, respectively. Reflux characteristics and gastric electric activity were compared between the two groups, and the correlation between gastric electric activity and reflux was analyzed.Results: Acid exposure time, total reflux episodes, and DeMeester score in the IEM group were higher than those in the NEM group. Distal mean nocturnal baseline impedance was significantly lower in the IEM group. Compared with the NEM group, the power ratio (PR) of fundus, antrum and pylorus and premeal and postmeal normal wave ratio of antrum were significantly lower in IEM. The total reflux episodes were negatively correlated with the PR of fundus and pylorus, and the DeMeester score was negatively correlated with the PR of corpus and pylorus.Conclusions: IEM may lead to increased reflux, resulting in esophageal mucosal damage.There may be consistency between abnormal esophageal motility and gastric motility.