This video presents a 31 year old, otherwise healthy male, with a five-year history of severe heartburn and lower substernal chest pain. Endoscopy revealed Grade III esophagitis with discrete ulcers and a large circumferential ulcer just above the lower esophageal sphincter. Biopsies showed the presence of Barrett's esophagus extending for greater than 3 cm above the lower esophageal sphincter. The patient was referred for surgical therapy due to his poor response to medical therapy and the presence of Barrett's esophagus.