Snapshot X-ray showing radiocontrast agent injected into the stomach entering the esophagus due to severe reflux. A 65 year-old male presents complaining of heartburn, belching, and epigastic pain. His symptoms are aggravated by drinking coffee and eating fatty foods. His heartburn improves when he takes calcium carbonate. Introduction Symptomatic reflux of gastric contents into the esophagus Transient lower esophageal spincter relaxation is the most common cause Other causes include login to view 7 more bullets Associated with: login to view 3 more bullets Presentation Symptoms login to view 7 more bullets Evaluation Diagnosis based on history Upper endoscopy login to view 2 more bullets 24-hour intraesophageal pH monitoring login to view 1 more bullet Manometry login to view 1 more bullet Treatment 1st line - lifestyle changes login to view 3 more bullets 2nd line login to view 3 more bullets 3rd line login to view 3 more bullets 4th line login to view 2 more bullets