Barrett`s esophagus is characterized by replacement of esophageal squamous epithelium with specialized intestinal metaplasia as a consequence of long standing gastro-esophageal reflux. It is a major risk factor for esophageal adenocarcinoma. With regard to the pathogenesis of Barrett`s esophagus other than acid reflux, hiatal hernia and duodenogastroesophageal bile reflux are implicated. According to several previous reports, acid reflux associated with bile reflux has been suggested to be a major risk factor for Barrett`s esophagus. This case study reports a patient with Barrett`s esophagus which developed one year after subtotal gastrectomy with gastroduodenostomy due to gastric cancer. Before the operation, the patient had a hiatal hernia but no Barrett`s esophagus. This case represents a significant model for the development of Barrett`s esophagus when acid reflux is combined with duodenogastroesophageal bile reflux. (Kor J Neurogastroenterol Motil 2006;12:77-80)