Athletes are susceptible to upper gastrointestinal complaints just like the general population. The most common etiologies are gastroesophageal reflux disease (GERD) and functional heartburn. If the signs and symptoms are compatible with GERD and the clinician has considered more serious pathology unlikely, a therapeutic trial with a proton pump inhibitor (PPI) can be initiated without further evaluation. The treatment for pure exertional GERD is similar but is guided by expert opinion only. Surgery has a limited role, but new techniques are evolving that may change the risk-to-benefit ratio. Chronic PPI therapy generally is safe, but there is a small risk of osteoporosis with concomitant fracture. There is no evidence for routine endoscopic screening for Barrett's esophagus or esophageal adenocarcinoma. For those who do not respond to treatment, the most likely diagnosis is functional heartburn. This is a diagnosis of exclusion, and referral to gastroenterology is warranted for diagnostic testing.