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A tired, middle-aged man walks into a pharmacy, coughing and clutching his chest. No heartburn, but plenty of discomfort, sharp pains, a lump-in-the-throat sensation, and throat clearing that won’t quit.

He’s been to urgent care twice, worried about a heart attack, but his ECGs came back clean. When the heart’s ruled out, doctors often look south — to the esophagus.

What he might be dealing with is “silent reflux,” formally known as laryngopharyngeal reflux (LPR), or its more well-known cousin, GERD.

Unlike classic reflux with heartburn, silent reflux can creep in without the usual burn but still do significant damage over time. One such consequence? Barrett’s Esophagus.

Barrett’s is when the cells lining your esophagus morph from flat, protective squamous cells to tougher columnar cells, ones more typical of stomach tissue. This occurs due to chronic exposure to stomach acid.

Think of it as the body trying to adapt to a harsh environment. Unfortunately, that adaptation slightly increases cancer risk.

The transformation is called “intestinal metaplasia.” Many don’t know they have Barrett’s until they undergo an upper endoscopy for vague symptoms like throat clearing, chest pain, or swallowing difficulties.

These complaints often get mistaken for allergies or anxiety. Meanwhile, acid quietly irritates the esophagus, causing cellular changes.

Symptoms include constant throat clearing, a feeling of food getting stuck, hoarseness, chronic cough, or a raw, burning chest pain.

In some cases, spasms can make it feel like a knife stabbing from the inside, yet heartburn is nowhere in sight. That’s silent reflux for you.

Now, having Barrett’s doesn’t mean you’re destined for cancer. Most people don’t progress to dysplasia (the fancy term for precancerous changes). But regular monitoring is key.

Men over 50, especially Caucasians, are at the top of the list. Add in obesity (especially belly fat), smoking, alcohol use (yes, vaping counts), poor diet and longstanding GERD, and you’ve got a high-risk combination.

Prevention and treatments

So how do you treat or prevent Barrett’s? Start by calming the acid storm.

Proton pump inhibitors (PPIs) are frontline. Dexilant is a strong option, but others like omeprazole or pantoprazole are commonly used.

Famotidine (Pepcid) is a gentler H2 blocker for nighttime relief. Sucralfate can coat and protect raw tissues, and there are others.

Lifestyle tweaks matter. Elevate your bed, eat smaller meals, skip food within three hours of bedtime, and ditch trigger foods: coffee, citrus, alcohol, chocolate, mint, fried stuff and carbonated drinks.

Weight loss, especially around the waist, can dramatically reduce reflux episodes.

For natural relief, teas like chamomile or marshmallow root can soothe irritation. Supplements such as DGL (deglycyrrhizinated licorice), slippery elm, and zinc carnosine help coat and heal.

Bottom line? If you’ve had reflux for years, even without heartburn, don’t ignore symptoms. Catching Barrett’s early means everything.

There’s a lot you can do to protect your esophagus and your future. If you’re interested in a deeper dive into this topic, see my longer article at suzycohen.com.

This information is opinion only. It is not intended to treat, cure or diagnose your condition. Consult with your doctor before using any new drug or supplement.  

Suzy Cohen is a registered pharmacist and author of The 24-Hour Pharmacist and Real Solutions from Head to Toe.