Epidemiological and clinical studies that have reported on gastro-oesophageal reflux disease (GERD), Barrett's oesophagus, oesophageal adenocarcinoma and Helicobacter pylori infection in sub-Saharan Africa were reviewed. The data indicate that Barrett's oesophagus is rare and oesophageal adenocarcinoma uncommon in all regions of sub-Saharan Africa studied (South Africa, Ethiopia, Nigeria, Zimbabwe, Kenya and Uganda). Hiatus hernia is also uncommon. There are too few reports of GERD to allow comment. The overwhelming majority of oesophageal cancers are squamous cell type. H. pylori infection is ubiquitous with an overall prevalence of 61-100%. It is concluded that although urbanization has resulted in an increase of risk factors associated with GERD, which would be expected to lead to an increase in this disease among Africans, this increase has not happened. It is believed that the critical factor preventing GERD in black Africans is H. pylori infection, which is usually acquired in childhood, is lifelong and is probably protective for the oesophagus.