Purpose <p>To evaluate the role of trans-abdominal shear wave elastography (SWE) of the esophagus to distinguish between patients with erosive and non-erosive reflux disease.</p> Methods <p>This prospective study enrolled 41 patients with clinically diagnosed gastroesophageal reflux disease (GERD) based on the DeMeester Score. They underwent further evaluation with white light endoscopy. Of these 41 patients, 13 were classified as Erosive Reflux Disease (ERD) and 28 as Non-erosive Reflux Disease (NERD) based on the presence or absence of erosions. 41 subjects who had come for an ultrasound for different clinical indications with no history or clinical symptoms of GERD and a DeMeester score of 0 were enrolled as controls. Greyscale ultrasound with SWE was done in all patients and controls. Four SWE parameters - mean, median, maximum, and minimum values - were calculated and compared amongst the three groups.</p> Results <p>Significant differences in all four SWE parameters of the esophagus, including mean, median, maximum, and minimum values, were observed between the patients with GERD as compared to the controls (<i>P</i> &lt; 0.001), with the SWE values being higher in cases. Significant differences in all four esophageal SWE parameters were also observed between patients with ERD and those with NERD (<i>P</i> &lt; 0.005), with SWE values higher in the ERD group. Regression analysis showed no significant relationships between SWE parameters and age or sex.</p> Conclusion <p>Transabdominal SWE may be a feasible and promising adjunctive imaging approach for assessing distal esophageal stiffness in patients with GERD. However, its diagnostic thresholds, reproducibility, and clinical utility require validation in larger, well-controlled, multicenter studies using standardized acquisition protocols and objective reflux testing.</p>