This study was designed to evaluate the utility of 99mTc pertechnetate esophageal scintigraphy for identifying Barrett's esophagus. Seventeen patients with Barrett's esophagus and seven patients with reflux esophagitis were studied. Eight of 17 patients with Barrett's esophagus had a positive image (sensitivity 47%). In contrast, none of the seven patients with esophagitis had a positive image (specificity 100%). Pentagastrin did not have a significant effect on the sensitivity. There was no correlation between the type of Barrett's epithelium and the sensitivity of the imaging results. However, the test is more frequently positive in those patients with more extensive disease. Our study indicates that technetium pertechnetate imaging should not be used as a screening test for the detection of Barrett's esophagus in patients with symptoms of gastroesophageal reflux, as the negative predictive value of the test is limited.