Barrett's esophagus has been described as a motility disorder of the esophagus, but the issue of whether or not the disorder precedes the columnar lining has been debated. Motility records of 70 patients with histologically proven Barrett's esophagus were analyzed. A comparison of the swallow responses was made between those patients who had a limited Barrett's segment (3 to 5 cm, n = 28) as opposed to those patients who had an extensive Barrett's segment (greater than 5 cm, n = 42). Patients with an extensive segment had a significantly lower amplitude (p < 0.01) of esophageal contraction and a significantly longer duration (p < 0.01) of contraction compared with patients with a limited segment. These differences were most marked in the distal esophageal segments. There was a progressive deterioration of esophageal motility with advanced disease.