Chronic gastroesophageal reflux disease (GERD) is a risk factor for the development of Barrett's esophagus, the predominant precursor to esophageal adenocarcinoma. It is important for the primary care physician to identify those at greatest risk of developing Barrett's esophagus for referral for appropriate endoscopic screening. Many older patients display atypical symptoms or may be asymptomatic. The primary care physician must maintain a high index of suspicion and refer anyone who may potentially be at risk of Barrett's esophagus to a gastroenterologist. Once a diagnosis of Barrett's esophagus is made, appropriate endoscopic surveillance is indicated. For patients who have progressed to dysplasia, endoscopic therapy has become the preferred treatment modality because of its comparable efficacy to surgical resection with lower morbidity and mortality.