Barrett esophagus produces no symptoms of its own. The columnar lining does not hurt, bleed, or obstruct by itself, so the condition is found in one of two ways: during endoscopy performed for reflux symptoms, or during a screening examination in a patient with the right risk profile. It cannot be recognised from the history alone.
Most patients with Barrett esophagus do have a history of GERD (gastroesophageal reflux disease). The usual symptoms are heartburn, a retrosternal burning that is often worse after meals, and acid regurgitation. Less common symptoms include dysphagia, a sore throat, hoarseness, chest pain, a chronic cough, and in some patients weight loss. Some patients have no reflux symptoms at all, and the diagnosis is then an incidental finding.
Those less common features matter because they change the question. Heartburn and regurgitation describe the reflux that led to the metaplasia, not the metaplasia itself, and their severity does not track the risk of cancer. Dysphagia, food sticking, unintentional weight loss, or gastrointestinal bleeding do not fit uncomplicated Barrett esophagus; they point to a complication such as ulceration or bleeding from reflux esophagitis, or, most importantly, to an adenocarcinoma that has already developed. They are an indication for prompt endoscopy rather than reassurance.
There are no specific physical examination findings. The diagnosis is made at endoscopy with biopsy, not at the bedside.