Barrett’s esophagus is the only known precursor lesion to esophageal adenocarcinoma. It is found in up to 15% of patients with gastroesophageal reflux disease (GERD) resulting in intestinal metaplasia of distal esophageal squamous epithelium to columnar epithelium. The diagnosis of Barrett’s esophagus is made with endoscopic and histologic findings (columnar metaplasia and goblet cells), limited to the esophageal mucosa. Risk factors for Barrett’s esophagus include chronic GERD, male sex, obesity, smoking, and increased age, with synergistic effects between these risk factors. The risk of neoplastic transformation increases with longer segments of Barrett’s metaplasia. Treatment and surveillance protocols are dictated by histology (nondysplastic, low grade dysplasia, and high-grade dysplasia).