In some of the patients, a history of heartburn is conspicuously absent. On radiography, the distinction cannot be made between squamous and columnar epithelium. A Barrett's esophagus, however, should be suspected when a punched-out esophageal ulcer is present that resembles a gastric ulcer in morphology or when an unexplained stricture is observed in the mid or proximal esophagus, both of which are demonstrated in this case. Most patients with a Barrett's esophagus, however, do not have either of these findings. A segmental reticular pattern of the esophageal mucosa is present in some patients.
Most patients demonstrate a hiatal hernia, gastroesophageal reflux, or both.
Peristalsis is usually normal, but some patients have impaired esophageal motor function and abnormal clearance.