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)