Metaplastic transformation of normal esophageal lining (squamous epithelium) into columnar epithelium result of chronic gastroesophageal reflux disease (GERD). Associated with the risk of progression to adenocarcinoma. Symptoms are heartburn, regurgitation while physical exam typically normal. Diagnosis with upper endoscopy with biopsy. TREATMENT is lifestyle modifications, weight loss, elevate head of bed, proton pump inhibitor for GERD. Regular endoscopic surveillance to monitor risk of dysplasia and carcinoma