Background: The efficacy and cost-effectiveness of screening, surveillance and treatment of Barrett s esophagus (BE) is controversial and it is unclear how practicing gastroenterologists implement available guidelines. We determined practice patterns and associated them with demographic factors, knowledge and opinions about efficacy and cost-effectiveness. Methods: 183 gastroenterologists were asked to fill out an anonymous questionnaire on screening for BE, surveillance of BE or microscopic intestinal metaplasia, treatment of BE, and eradication of H. pylori. We also assessed the respondents' knowledge and opinion of the efficacy and cost-effectiveness of these practices. Data were analyzed using multivariate logistic regression. Results: 103 gastroenterologists responded. 14% were academic physicians, 6% worked in county/VA hospitals, and 80% were in private practice. Many respondents screened or surveyed patients at least once a year (table). 18% of respondents routinely performed ablative photodynamic therapy for BE. 3% referred patients with low-grade dysplasia for esophagectomy; the remainder continued endoscopic surveillance with or without ablation. 85% referred patients with high-grade dysplasia for esophagectomy. Over 81% treated asymptomatic BE patients with proton pump inhibitors, but only 56% believed that this would reduce cancer risk. 34% favored fundoplication as first-line treatment for BE, and 59% eradicated H. pylori in all BE patients. Factors predictive of surveillance practices were the physician's belief in efficacy and cost-effectiveness. Demographic factors were not predictive. Conclusions: Most gastroenterologists carry out BE screening and surveillance. Although belief in efficacy and cost-effectiveness are independent predictors of practice behavior, many physicians perform screening/surveillance mainly because of medico-legal considerations.