Biopsies from short segments of columnar appearing mucosa in the distal esophagus often fail to reveal intestinal metaplasia (IM). The yield of IM on repeat upper endoscopy (EGD) and biopsy in these patients is not known. Our aim was to prospectively evaluate the yield of IM on repeat EGD in patients with suspected SSBE (negative for IM on first EGD). Forty-three patients with suspected SSBE underwent repeat EGD with biopsy. This included 42 men and 1 woman, mean age 53 years (range: 45-90) with a mean columnar mucosa length of 1.26 cm (range: 0.5-2.5). On repeat EGD, 10 of 43 patients (23.2%) had evidence of IM. There was no statistically significant difference between the patients with proven SSBE on repeat EGD compared to those with persistent negative IM with regards to age, ethnicity, length of columnar mucosa, GERD symptoms, and hiatal hernia size. In conclusion, more than 20% of patients with suspected SSBE have evidence of IM (ie, proven SSBE) on repeat EGD. Thus repeat EGD with biopsy may be warranted in patients with tongues of columnar mucosa in the distal esophagus but no IM on the first biopsy to confirm the diagnosis of SSBE.