The accuracy of patients' symptom localization in dysphagia is not clear. This study aims to determine the accuracy of patient localization and to determine the correlation of localization with motility disorders. We reviewed 100 patients after completion of EGD, manometry, and a dysphagia questionnaire. Proximal and midesophageal localization were rarely associated with a proximal cause of dysphagia. Distal localization correlated in 80% of cases. Fifty-seven percent of patients reporting diffuse symptoms had manometric abnormalities, but only 9% of patients with manometric abnormalities reported diffuse symptoms. In conclusion, patient localization in esophageal dysphagia is not accurate. The data suggest that proximal localization is especially inaccurate, whereas distal localization may be more accurate. Finally, there is no correlation between diffuse localization and diagnosis of motility disorders.