Columnar-lined or Barrett's esophagus is a consequence of chronic gastroesophageal reflux and often represents severe reflux disease. Abnormalities of motility in Barrett's esophagus, therefore, are similar to those in patients with severe reflux esophagitis. Patients with Barrett's esophagus have a high prevalence of defective basal lower esophageal relaxations. Impaired esophageal peristalsis is more common than in patients with mild reflux esophagitis and comparable to patients with severe esophagitis. Systemic diseases associated with impaired esophageal motility may, as a consequence of chronic gastroesophageal reflux, predispose to Barrett's esophagus. In patients with Barrett's esophagus, there is little evidence that the esophageal motility abnormalities improve with either medical therapy or antireflux surgery.