Objective To analyze the change characteristics of tongue manifestation as the precancerous disease of the esophagus progresses of reflux esophagitis（RE） and Barrett′s esophagus. Methods Based on the screening of esophageal carcinoma in high-risk areas

the propensity score matching（PSM） method was used to match the mild RE group to the moderate-severe RE and Barrett′s esophagus group at a ratio of 1 ∶2 by general population characteristics

lifestyle and related diseases. Multivariate logistic regression in combination with PSM method were used to analyze the distribution law of tongue manifestation after adjustment and the change characteristics of tongue manifestation from RE to Barrett′s esophagus. Result A balanced exposure groups at baseline was achieved by adjusting general population characteristics

lifestyle and related diseases through PSM（|d| > 0.25）. After further adjustment by PSM

multivariate logistic regression analysis showed that mild RE was significantly associated with gray and black coating（OR=1.540

95% confidence interval（CI） 1.120 to 2.119）

crimson tongue（OR=1.529

95%CI 1.028 to 2.275）

dusky red tongue（OR=1.291

95%CI 1.128 to 1.479）

and purple tongue（OR=1.532

95%CI 1.237 to 1.896）; moderate-severe RE was significantly related with tongue stasis（OR=1.681

95%CI 1.068 to 2.648） and gray and black tongue（OR=4.719

95%CI 1.858 to 11.987）; Barrett′s esophagus was associated with purple tongue（OR=3.447

95%CI 1.206 to 9.853）. Conclusion Tongue stasis is a risk factor for the transformation from RE to Barrett′s esophagus.