Isabel, a 24-year-old Latina, was recently married and started doing lots of home cooking. At her annual gynecological exam, she asks her women's health physician if she can refer her to a physician specializing in "stomach or heart problems." Apparently, Isabel has been feeling a pain in her chest or upper abdomen nearly every evening, especially right before bed or right when she lies down. She describes the pain as a burning or gnawing pain. Isabel mentions that because of their work schedules, she and her husband usually do not eat dinner until about 8:00 at night. Isabel is a long-time smoker and has an occasional alcoholic drink.