The modern concept of Barrett’s esophagus (Barrett’s esophagus) refers to a phenomenon in which the normal squamous epithelium of the lower esophagus is replaced by entericized columnar epithelium due to gastroesophageal reflux disease, an adaptive response of the esophagus to gastric acid and bile salt injury. It was first reported by the Australian surgeon Barrett in 1950, hence the name. Barrett’s esophagus itself does not cause any discomfort, but a few patients can go through the heterogeneous proliferation stage and develop esophageal adenocarcinoma. Therefore, true Barrett’s esophagus in principle requires regular endoscopic biopsy follow-up. Endoscopy combined with biopsy pathology is the gold standard for the diagnosis of Barrett’s esophagus. Endoscopy is extremely easy to detect areas of esophageal squamous epithelium replaced by columnar epithelium, but it is not possible to identify the presence of entericized epithelial cells in the area and requires pathological examination of a few biopsies clamped in the area for confirmation. In retrospect, it is clear that initially, whenever there was an area of squamous epithelium replaced by columnar epithelium in the lower esophagus, it was diagnosed as Barrett’s esophagus, with or without enterosis. Endoscopic examination was clear at a glance. Later it was found that if there was only columnar epithelial replacement without intestinalization there was no risk of cancer and no treatment was necessary. The attention of medical doctors has since been focused on cases with intestinalization, and it has been emphasized that intestinalization must be present to diagnose Barrett’s esophagus. Because endoscopy can only find columnar epithelial replacement areas but cannot identify whether there are entericized cells interspersed in them, the diagnosis also requires more biopsy pathology. However, many endoscopy institutions in China and individual foreign scholars still diagnose Barrett’s esophagus based on endoscopy alone, which leads to some confusion and unnecessary panic. In fact, many of the Barrett’s esophagus on our endoscopy reports are scattered islands of columnar epithelial metaplasia without the risk of cancer, without intestinalization. Even in the modern concept of Barrett’s esophagus or Barrett’s esophagus with intestinalization, the probability of carcinoma is very low, with an annual probability of carcinoma of about 1%, and it mainly occurs in patients with length greater than 3 cm. For the management of Barrett’s esophagus, the principle is to follow up with regular endoscopic biopsy, and once the heterogeneous growths are found, endoscopic excision can be performed if the diagnosis is confirmed. In the case of highly nervous people and those who cannot be relieved by the answer, direct resection can be considered without the presence of anomalous growths. As for medication, the main treatment is to control gastroesophageal reflux. For formed Barrett’s esophagus, there is no drug that has proven to be effective, no matter how wonderfully named it is.