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Barrett's esophagus is present in approximately 6 %-12 % of patients undergoing endoscopy for symptomatic gastroesophageal reflux disease. It is currently defined as the presence of columnar epithelium of any length in the distal esophagus, if biopsies in these segments reveal specialized intestinal metaplasia with goblet cells when a combined hematoxylin and eosin/Alcian blue stain of pH 2.5 is applied. Segments less than 3 cm in length and greater than 3 cm are called short-segment and long-segment Barrett's esophagus, respectively. Barrett's esophagus is the only clearly recognized risk factor for adenocarcinoma of the esophagus and this risk is associated topographically with the areas of specialized intestinal metaplasia. Adenocarcinoma of the esophagus is detected with increasing frequency and its incidence continues to rise. The estimated annual cancer risk for a given patient with Barrett's esophagus is approximately 0.5 %. The 5-year survival rate for this malignancy remains dismal, because survival is stage-dependent and currently most cancers are at advanced stages when detected. Strategies for an improved survival rate among patients with adenocarcinoma of the esophagus focus on improving the diagnosis of Barrett's esophagus, on better identification of dysplasia, and on detection of cancer at earlier and potentially curable stages.