Objective To investigate the relationship among symptoms, endoscopic classification and pathological characteristics of Barrett esophagus (BE). Methods A total of 7 150 patients undergoing gastroscopic examinations for upper gastrointestinal tract symptoms were investigated with gastroesophageal reflux disease (GERD) questionnaire (GerdQ), and GERD was diagnosed when GerdQ sum score was ≥8. Among those diagnosed as BE by gastroscopic examinations, long-segment BE (LSBE) group (n=27) and short-segment BE (SSBE) group (n=65) were divided according to the morphology under gastroscope, and 78 patients with cardia intestinal metaplasia (CIM) were served as controls (CIM group). The esophagitis was observed under endoscope in each group. The biopsy specimens were obtained, and the histopathological features, dysplasia and helicobacter pylori (H.pylori) infection were observed with HE, AB and Giemsa staining respectively. Results Endoscopic examinations revealed that the prevalence of BE was 1.29%. The prevalences of GERD in LSBE group, SSBE group and CIM group were 92.59%, 69.23% and 41.03% respectively, the prevalences of esophagitis were 100.00%, 78.46% and 29.49% respectively, and the prevalences of dysplasia were 66.67%, 24.62% and 10.26% respectively, with significant differences among groups (P＜0.05 or P＜0.01). The prevalence of intestinal metaplasia in LSBE group was 74.07%, which was significantly higher than that in SSBE group (50.77%)(P＜0.05). The Hp infection rates in LSBE group and SSBE group were 18.52% and 21.54% respectively, which were significantly lower than that in CIM group (47.44%)(P＜0.05). Crypt disarray and atrophy, squamous epithelium overlying columnar crypts, intestinal metaplasia, esophageal ducts and multilayered epithelium were more likely to be found in patients with BE group than in CIM group (P＜0.05), and squamous epithelium overlying columnar crypts and esophageal ducts were exclusively found in patients with BE. Conclusion GERD, esophagitis, specialized intestinal metaplasia and dysplasia are more likely to occur in patients with BE, especially in those with LSBE. The Hp infection rate in patients with BE is low. Crypt disarray and atrophy, squamous epithelium overlying columnar crypts, intestinal metaplasia, esophageal ducts and multilayered epithelium are associated with the diagnosis of BE. Squamous epithelium overlying columnar crypts and esophageal ducts are exclusively in patients with BE.