A retrospective study for assessment of the prevalence of Helicobacter pylori was performed in 107 consecutive patients with columnar-lined epithelium in the esophagus. The presence of hiatal hernia and esophagitis was noted. From 71 patients, biopsy specimens were available for analysis. No difference in the presence or absence of H. pylori was noted, regardless of whether or not there was esophagitis or hiatal hernia. Most H. pylori-positive patients show a low bacterial load in the metaplastic epithelium. It is assumed that the finding of H. pylori in columnar-lined epithelium reflects a shift in the bacterium from the gastric antrum. H. pylori probably has no etiologic role of esophagitis in Barrett's mucosa.