Recent rapid increases in the incidence of oesophageal adenocarcinoma and Barrett’s metaplasia in western populations have led to a number of large-scale studies seeking to identify the causes of these conditions. Two of the largest and most comprehensive studies have been conducted in Australia. These studies have confirmed the long-standing clinical impression that gastro-oesophageal acid regurgitation is the principal cause of these diseases, and identified a number of other factors either positively (smoking, obesity) or negatively (H pylori infection, NSAIDs) associated with risk. Of these latter factors, it is the role of central obesity that has garnered most attention, since this may explain the five-fold higher incidence of this cancer amongst males compared with females. Genetic factors remain largely unexplored, although this will soon be rectified when the international Barrett’s Oesophagus and Adenocarcinoma Consortium (BEACON) completes their genome-wide association study in late-2012.