Barrett's esophagus is a disease that is common in patients with gastroesophageal reflux of acid but may also occur in association with bile reflux and rarely with other factors. It cannot be reliably distinguished from patients with reflux alone on the basis of demographic factors, clinical characteristics, or manometry. Radiology only serves to make Barrett's epithelium less likely in the presence of a completely normal study. The gold standard for diagnosing Barrett's esophagus is still multiple biopsies taken at the time of endoscopy. By performing multiple biopsies at various levels, the gastroenterologist will be effective not only in diagnosis but in selecting and screening that subset of patients with dysplasia that may predict coexisting or future adenocarcinoma. Treatment of high-grade dysplasia or carcinoma is resection, whereas medical treatment or fundoplication is still directed at the severity and complications of gastroesophageal reflux rather than at Barrett's characteristics alone. A decision tree given in Figure 5 summarizes these recommendations.