Chocolate has been shown to decrease mean basal lower esophageal sphincter (LES) pressure, providing a rationale for the pathogenesis of chocolate-induced reflux symptoms. We assessed the relationship between chocolate ingestion and increased esophageal acid exposure using intraesophageal pH monitoring. Compared with ingestion of a dextrose control solution of similar volume, osmolality, and calories, postprandial ingestion of chocolate resulted in a significant increase in acid exposure in the first postprandial hour in patients with esophagitis. We conclude that this finding supports recommendations that patients with reflux esophagitis abstain from chocolate.