Gastroesophageal reflux (GER) and its associated symptoms are common among athletes. In the athlete, GER increases with intensity of exercise, is more common with endurance sports, and worse with postprandial exercise. GER has symptoms that overlap with other upper gastrointestinal (GI) conditions. Symptoms of GER can be difficult to distinguish from cardiac chest pain. GER may exacerbate asthma. Proposed mechanisms causing GER during exertion include altered GI blood flow and motor function, neuroendocrine changes, and mechanical effects. GER symptoms that interfere with activity may respond to lifestyle modification or pharmacologic therapy.