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Cliccare qui per andare alla sezione Riferimenti</sup> has stimulated surgeons, gastroenterologists, pathologists, and geneticists to participate in the 35-year-old controversies of Barrett's columnar-lined esophagus (BE). The original debate as to whether BE is congenital or acquired has shifted to a debate as to the exact cell of origin in the epithelium. In fact, the current consideration to be resolved is whether the mere presence of goblet cells, which identify BE at the gastroesophageal junction, represents the very earliest sign of BE. Surgeons too have presented some evidence to favor surgical treatment rather than long-continued antacid therapy, and the facts need to be reviewed realistically. Potent acid-inhibitory drugs give excellent symptomatic relief, but with a background of possible long-term adverse effects and significant costs. The need and details of surveillance programs to detect early cancer are also not resolved, and the application of genetic markers is still deliberated and progressing. This article focuses on these many controversies and attempts to consolidate the present knowledge with a view to a practical approach to the management of BE.