The management of Barrett's oesophagus should aim to treat symptoms, and prevent complications of reflux. Treatment of choice is a proton pump inhibitor, with the option of surgical treatment in younger patients. Uncertainties remain about the significance of short segment Barrett's oesophagus. Doubts also remain about the benefit and cost-effectiveness of conventional surveillance of Barrett's oesophagus; for patients with an annual cancer risk of 0.5% 5-yearly endoscopy and biopsies for patients without dysplasia represent the best strategy Novel modalities such as photodynamic therapy have shown encouraging results for high grade dysplasia or early cancer for patients unsuitable for surgery. Finally, agents such as cyclooxygenase-2 inhibitors hold promise for prevention of malignancy in Barrett's oesophagus.