During the last 30 years, the incidence of oesophageal adenocarcinoma has increased rapidly. Patients with Barrett's oesophagus have an increased risk of developing oesophageal adenocarcinoma and should be kept under surveillance. However, only a subset of Barrett's oesophagus patients will eventually develop malignancy and surveillance programs using endoscopy and histopathology cannot efficiently identify this subgroup. The study of additional prognostic factors is therefore of major importance and the p53 tumour suppressor gene has attracted much attention in this respect. Several investigators have found that p53 alteration is a frequent event in oesophageal adenocarcinomas and is associated with malignant transformation of Barrett's oesophagus. p53 appears to be a promising prognostic marker in Barrett's oesophagus and, as research progresses, possible clinical applications are emerging.