This article explores the historical roots for the present confusion regarding diagnostic criteria for Barrett's esophagus. The author recommends using an alternative classification system for the columnar-lined esophagus that does not rely solely on arbitrary and imprecise endoscopic landmarks and measurements. Endoscopic features that suggest the presence of intestinal metaplasia in the esophagus are discussed and illustrated. The role of endosonography and the endoscopic techniques for ablating the esophageal columnar lining also are considered. Finally, the author lists specific management recommendations for patients who have esophageal columnar metaplasia.