How does smoking affect heartburn and GERD. What are the mechanisms behind cigarette-induced acid reflux. Why quitting smoking can alleviate GERD symptoms. How does nicotine impact the lower esophageal sphincter.

The Basics of Heartburn and Acid Reflux

Heartburn is a common symptom characterized by a burning sensation in the chest. It’s often associated with acid reflux, a condition where stomach acid flows back into the esophagus. When acid reflux becomes chronic, it’s diagnosed as gastroesophageal reflux disease (GERD).

The lower esophageal sphincter (LES) plays a crucial role in preventing acid reflux. This ring of muscle at the junction of the esophagus and stomach normally closes tightly after food passes through. When the LES fails to close properly, stomach contents can regurgitate into the esophagus, causing discomfort.

Common Symptoms of Acid Reflux and GERD

• Burning sensation in the chest (heartburn)
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in the throat

Is GERD a serious condition? While occasional heartburn is common, chronic GERD can lead to more severe complications if left untreated. These may include esophagitis, strictures, Barrett’s esophagus, and even an increased risk of esophageal cancer.

The Smoking-GERD Connection: How Cigarettes Exacerbate Acid Reflux

Numerous studies have established a strong link between smoking and an increased risk of GERD. Smokers are more likely to experience frequent heartburn and other symptoms of acid reflux compared to non-smokers. But how exactly does smoking contribute to this digestive disorder?

Nicotine’s Effect on the Lower Esophageal Sphincter

One of the primary mechanisms by which smoking affects GERD is through nicotine’s impact on the lower esophageal sphincter. Nicotine acts as a relaxant on smooth muscle tissue, including the LES. When this sphincter is relaxed, it’s more likely to allow stomach contents to flow back into the esophagus.

How quickly does nicotine affect the LES? Studies have shown that the effects can be almost immediate. Even a single cigarette can cause the LES to relax, potentially leading to acid reflux episodes in susceptible individuals.

Reduced Saliva Production in Smokers

Saliva plays a crucial role in neutralizing acid in the mouth and esophagus. It contains bicarbonate, which helps buffer acid and protect the esophageal lining. Smoking, however, can reduce saliva production, leaving the esophagus more vulnerable to acid damage.

How much does smoking affect saliva production? Research indicates that chronic smokers may produce up to 30% less saliva compared to non-smokers. This reduction in saliva flow can significantly impact the body’s natural defense against acid reflux.

Smoking’s Impact on Stomach Acid Secretion

Cigarette smoking doesn’t just affect the esophagus; it also alters stomach acid production and composition. Smokers often experience increased acid secretion, which can exacerbate GERD symptoms.

Changes in Stomach Acid Composition

Smoking can lead to changes in the composition of stomach acid, making it more harmful to the esophagus. The increased presence of bile salts and other compounds in smokers’ stomach acid can make reflux episodes more damaging and symptomatic.

Does smoking increase stomach acid production? Yes, studies have shown that smoking can stimulate the production of stomach acid. This increase in acid production, combined with the LES-relaxing effects of nicotine, creates a perfect storm for acid reflux.

The Effect of Smoking on Esophageal Function

Beyond its impact on the LES, smoking also affects the overall function of the esophagus. The esophagus relies on coordinated muscle contractions to move food and liquids toward the stomach, a process known as peristalsis.

Impaired Esophageal Motility in Smokers

Nicotine’s muscle-relaxing properties extend to the entire length of the esophagus. This can lead to impaired esophageal motility, making it more difficult for the body to clear refluxed acid from the esophagus.

How does impaired motility contribute to GERD? When the esophagus can’t efficiently clear refluxed acid, it prolongs exposure time, increasing the risk of irritation and damage to the esophageal lining.

Smoking and GERD Complications

Chronic GERD in smokers can lead to a range of complications, some of which can be serious. The combination of increased acid exposure and reduced protective mechanisms can accelerate damage to the esophagus.

Increased Risk of Barrett’s Esophagus

Barrett’s esophagus is a condition where the lining of the esophagus changes, becoming more like the lining of the intestine. This change is often a result of long-term acid exposure and is considered a precancerous condition.

Are smokers at higher risk for Barrett’s esophagus? Yes, studies have shown that smokers with GERD are more likely to develop Barrett’s esophagus compared to non-smokers with GERD. This increased risk underscores the importance of smoking cessation for GERD management.

Esophageal Cancer Risk

While the overall risk remains low, chronic GERD is associated with an increased risk of esophageal adenocarcinoma. Smoking further amplifies this risk, creating a synergistic effect that significantly elevates cancer risk in individuals with long-standing GERD.

The Benefits of Quitting Smoking for GERD Management

For individuals with GERD, quitting smoking can lead to significant improvements in symptoms and overall digestive health. The benefits of smoking cessation on GERD are often noticeable within a short period.

Immediate and Long-term Effects of Smoking Cessation

• Improved LES function
• Reduced acid reflux episodes
• Increased saliva production
• Better esophageal motility
• Decreased risk of GERD complications

How quickly can GERD symptoms improve after quitting smoking? Many individuals report a reduction in heartburn and other GERD symptoms within days to weeks of quitting. However, the full benefits, particularly in terms of reduced cancer risk, may take years to manifest.

Strategies for Managing GERD in Smokers

While quitting smoking is the most effective strategy for reducing GERD symptoms in smokers, it’s not always an easy process. In the meantime, there are several approaches that can help manage GERD symptoms in individuals who continue to smoke.

Lifestyle Modifications

1. Avoid smoking before meals and bedtime
2. Elevate the head of the bed
3. Avoid tight-fitting clothing
4. Maintain a healthy weight
5. Avoid trigger foods (e.g., spicy, fatty, or acidic foods)

Medical Management

In addition to lifestyle changes, various medications can help manage GERD symptoms. These may include:

• Antacids for quick relief of heartburn
• H2 blockers to reduce acid production
• Proton pump inhibitors (PPIs) for long-term acid suppression

Can medications fully counteract the effects of smoking on GERD? While medications can provide significant symptom relief, they cannot completely negate the harmful effects of smoking on the digestive system. Smoking cessation remains the most effective long-term strategy for GERD management in smokers.

The Role of E-cigarettes and Vaping in GERD

With the rise of e-cigarettes and vaping, questions have emerged about their impact on GERD compared to traditional cigarettes. While research is still ongoing, early studies suggest that e-cigarettes may also contribute to GERD symptoms, albeit potentially to a lesser extent than conventional cigarettes.

Nicotine Delivery and GERD Risk

E-cigarettes and vaping devices deliver nicotine without the combustion products found in traditional cigarettes. However, the presence of nicotine still poses a risk for GERD symptoms due to its effects on the LES and esophageal function.

Are e-cigarettes a safer alternative for individuals with GERD? While e-cigarettes may reduce exposure to some harmful chemicals found in cigarette smoke, they still contain nicotine and can contribute to GERD symptoms. The safest approach for individuals with GERD is to avoid all forms of nicotine use.

Future Directions in Research and Treatment

As our understanding of the relationship between smoking and GERD continues to evolve, researchers are exploring new avenues for treatment and prevention. Future studies may focus on developing targeted therapies that address the specific mechanisms by which smoking affects the digestive system.

Potential Areas of Research

• Novel medications to counteract nicotine’s effects on the LES
• Gene therapy approaches to enhance esophageal protection
• Advanced smoking cessation techniques for individuals with GERD
• Personalized treatment strategies based on genetic and environmental factors

What role might artificial intelligence play in GERD management? AI-driven technologies could potentially help predict GERD risk, optimize treatment plans, and provide personalized lifestyle recommendations for individuals struggling with both smoking and GERD.

In conclusion, the relationship between smoking and GERD is complex and multifaceted. From its effects on the lower esophageal sphincter to alterations in stomach acid composition, smoking significantly impacts the digestive system in ways that promote acid reflux and its complications. While managing GERD symptoms in smokers can be challenging, a combination of lifestyle modifications, medical management, and ultimately, smoking cessation can lead to significant improvements in digestive health and overall well-being. As research in this field continues to advance, new strategies for prevention and treatment may emerge, offering hope for more effective management of GERD in both smokers and non-smokers alike.

Cary Gastroenterology Associates | The Impact of Smoking on Heartburn

Even though cigarette smoking has been on the decline in recent years, it continues to be one of the leading causes of preventable death in the United States. Each year, nearly half a million people die from diseases that are related to smoking. In addition to being unhealthy and dangerous, though, smoking can also have adverse effects on a number of different conditions that would normally be mild concerns. One common example of a condition that can be exacerbated by cigarette smoking is heartburn.

What is Heartburn?

Heartburn is a general term that refers to a burning sensation that is usually felt in the center of the chest, though in some circumstances the discomfort can radiate to the throat, neck, or upper arms. Rather than a disease in itself, heartburn is usually one of a group of symptoms that are associated with various gastrointestinal problems. Though there are numerous potential causes of heartburn, the most common causes are indigestion, acid reflux, and gastroesophageal reflux disease (GERD).

Regardless of the underlying condition, however, the primary mechanism of heartburn is related to the opening and closing of the lower esophageal sphincter; this ring of muscle, along with its partner at the top of the esophagus, is responsible for allowing food to pass into the stomach after being swallowed. Once the food has passed, the sphincter then re-closes to prevent stomach contents from backing up into the esophagus. This is important since the peristaltic contractions of the stomach can be vigorous and therefore slosh digestive juices all around the stomach.

Sometimes, though, the lower esophageal sphincter either fails to close or closes in an incomplete way; when this happens, stomach acid can make its way back through the lower esophageal sphincter and up into the esophagus. Because stomach acid contains hydrochloric acid (in addition to various digestive enzymes), contact with the mucosa lining of the esophagus can cause notable pain or discomfort. The nature of how this discomfort is experienced is in large part based on how far up the esophagus the stomach acid is regurgitated.

This phenomenon of acid rising up into the esophagus is typically referred to as acid reflux. In addition to heartburn, symptoms of acid reflux include chest pain, bad breath, and even breathing problems. When acid reflux becomes chronic and a regular occurence, it then is known as gastroesophageal reflux disease (GERD). GERD is usually a more serious condition that can lead to other illnesses like esophagitis, stricture (narrowing of the esophagus), asthma, sinusitis, and Barrett’s Esophagus, a precancerous change to the makeup of the esophageal lining.

How Does Smoking Affect Heartburn?

It may seem counterintuitive that smoking could cause or contribute to heartburn, but studies have shown that there is a close link between smoking and GERD. And just as the act of smoking can lead to or worsen GERD, the act of quitting smoking often gives patients noticeable relief from GERD symptoms. Below are some of the ways smoking can bring about heartburn (among other symptoms):

• Lower Esophageal Sphincter: One of the effects of nicotine on the body is that it acts as a relaxant to smooth muscle. Since the lower esophageal sphincter is composed of smooth muscle, the intake of nicotine during smoking can cause the muscle to relax and function improperly. In these circumstances (especially if combined with any other gastroesophageal problems), stomach acid can leak through and cause heartburn.
• Salivation: Saliva is secreted by salivary glands in the mouth and is used to wetten food and begin the digestive process; enzymes in saliva break down fats and starches as well protecting the mouth from tooth decay. Another component of saliva, bicarbonate, actually helps mitigate any normal reflux that might occur. In smokers, however, reduced saliva production means being less able to neutralize acid reflux and heartburn.
• Acid Secretion: In a normally functioning digestive system, the compounds found in stomach acid are balanced so that digestion can happen efficiently while also not causing acid damage. When people smoke regularly, though, additional bile salts and other normally beneficial elements may enter the mix and make it essentially more potent. This combination of factors due to nicotine means that even more stomach acid can slosh around and potentially back up into the esophagus.
• Esophageal Muscles: As with the lower esophageal sphincter, nicotine can also relax the smooth muscle that lines the entire length of the esophagus. The fibromuscular nature of the esophagus allows it to use contractions to push food down into the stomach. But when the nicotine from tobacco smoke causes these muscles to relax, the esophagus is less able to resist and eliminate any acid that has refluxed.
• Esophageal Lining: While cigarette smoke doesn’t directly damage the lining of the esophagus, it can negatively affect several factors that protect or heal the lining: decreased blood flow, reduced mucus secretion, and reduced sodium bicarbonate production (as noted above). Over time, the confluence of these effects can cause damage to the lining itself and even potentially to the DNA of the epithelial cells.

Heartburn Treatment: Quit Smoking

The normal treatment for heartburn is over-the-counter antacids or modifications to one’s diet. There are also some practical methods like not lying down right after eating or elevating the head of your bed in order to avoid acid reflux. For non-smokers, these methods can go a long way toward relieving discomfort and reducing the frequency of heartburn incidents. For those who smoke, on the other hand, the most important treatment factor is also the simplest: just quit smoking.

Of course, quitting smoking is generally easier said than done because of how chemically addictive nicotine is. Many people try and fail numerous times before finally kicking the habit. The truth is, though, that the health benefits of quitting smoking go far beyond simply reducing the chances for heartburn; blood pressure, circulation, lung function, and the chances of getting various forms of cancer all begin to improve quickly after quitting.

Over many decades, many different options have been developed that are designed to help people quit smoking. One of the most popular examples is the nicotine patch, a small patch that adheres to the skin and releases small amounts of nicotine to help you manage withdrawal symptoms; a similar product is nicotine gum that releases nicotine as you chew. There are also now some prescription medications that can fight cravings or generally manage the process of cessation.

Consider Talking With a Doctor

If you’re a smoker, heartburn is just one minor concern among a wide variety of possible health problems related to gastroenterology. Indeed, smoking can lead to or contribute to numerous gastrointestinal conditions that can negatively impact your quality of life. If you’d like to learn more about the benefits of quitting, or if you have symptoms of a digestive illness that isn’t improving, contact us at Cary Gastro to speak with a gastroenterologist and request an appointment. We are dedicated to providing excellent digestive health care!

Author

Mane Ideas

Gastroesophageal Reflux Symptoms Abate When Smoking Stops | Gastroenterology | JAMA

Gastroesophageal Reflux Symptoms Abate When Smoking Stops | Gastroenterology | JAMA | JAMA Network










[Skip to Navigation]

This Issue

View Metrics

• 
  Download PDF
• 
  Full Text




• 
  Share

  
  Twitter
  Facebook
  Email
  LinkedIn

• 
  Cite This
• 
  Permissions

Clinical Trials Update

January 22/29, 2014

Anita Slomski

JAMA. 2014;311(4):349. doi:10.1001/jama.2013.286076

Full Text

Quitting smoking improved gastroesophageal reflux symptoms (GERS), but only in individuals of normal weight who used antireflux medications at least weekly, according a prospective study of the population of Nord-Trøndelag County, Norway (Ness-Jensen E et al. Am J Gastroenterol. doi:10.1038/ajg.2013.414 [published online December 10, 2013]). The investigators used data from 29 610 individuals who reported having GERS during both of 2 health surveys—from 1995 to 1997 and from 2006 to 2008. In the subset of respondents with severe GERS (1553 individuals), they examined GERS status among those who had quit smoking between the 2 survey periods, status among those who had sustained their smoking, and the association of symptoms with the usage of antireflux medications.

Full Text

Add or change institution

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Assisted Reproduction
• Bleeding and Transfusion
• Cardiology
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life
• Environmental Health
• Equity, Diversity, and Inclusion
• Ethics
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Geriatrics
• Global Health
• Guide to Statistics and Methods
• Guidelines
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Informatics
• Health Policy
• Hematology
• History of Medicine
• Humanities
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Melanoma
• Mobile Health and Telemedicine
• Narrative Medicine
• Nephrology
• Neurology
• Neuroscience and Psychiatry
• Notable Notes
• Nursing
• Nutrition
• Nutrition, Obesity, Exercise
• Obesity
• Obstetrics and Gynecology
• Occupational Health
• Oncology
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Pediatrics
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Poetry
• Population Health
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Radiology
• Regulatory Agencies
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgery
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Toxicology
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Urology
• Users’ Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Violence
• Women’s Health
• Workflow and Process
• Wound Care, Infection, Healing

Save Preferences

Privacy Policy | Terms of Use

Tobacco-free Germany: By 2040, Germans can completely quit cigarettes

Adopt a mandatory strategy

In the European standings, Germany is among the countries lagging behind in terms of tobacco prevention. Today almost a quarter of the country’s adult population regularly smokes in the republic. Every year, 85,000 people develop cancer caused by chronic smoking, and 127,000 people die from the consequences of tobacco abuse.

On the eve of the upcoming elections to the Bundestag, German scientists and health professionals called on German politicians to take decisive steps on this issue and to develop a joint strategy to control tobacco smoking. They advocate the adoption of a mandatory strategy to combat tobacco addiction among Germans. Their main goal is to achieve less than five percent of German adults and less than two percent of teenagers using tobacco and e-cigarettes by 2040. The staff of the German Cancer Research Center (Deutsches Krebsforschungszentrum (DKFZ) and the German Cancer Organization (Deutsche Krebshilfe) played an important role in the development of the document.

“A political decision needs to be made to reduce tobacco use and thus protect the health of the population,” said Michael Baumann, Chairman of the Board of the German Cancer Research Center, who led the scientific team behind the strategy. According to him, the plan of specific measures and the roadmap for their implementation is a serious basis for achieving this goal.

Reduce the attractiveness and availability of tobacco

The policy paper presents a number of serious constraints for the tobacco industry to position its products as part of an attractive lifestyle. In particular, this includes significant restrictions on the availability of tobacco products, regular and significant tax increases, including on electronic cigarettes. In addition, it is necessary to facilitate access to free offers of help to stop smoking, and, if necessary, to full-fledged treatment for nicotine addiction.

“With a mandatory strategy to drastically reduce tobacco use by 2040, Germany could be in the league of countries that care the best about the health of their citizens,” said Gerd Nettekoven, Chairman of the Board of the German Cancer Organization.

Taking a cue from Ireland, the Netherlands and Finland

Scientists say that to create a completely tobacco-free society, decisive action is needed on the part of politicians responsible for making decisions, as well as protecting health policy interests from the influence of tobacco manufacturers and tobacco products.

Many European countries are already implementing similar strategies to help their citizens break free from nicotine addiction. Ireland, the Netherlands and Finland, in particular, have made significant progress. According to scientists, Germany should follow their example, and the new government is obliged to include a strategy for a nicotine-free Germany by 2040 in the coalition agreement of the ruling parties.

Irina Mikhailina

German smokers may be “isolated from society” – DW – 08/07/2006

08/07/2006 August 7, 2006

In Germany, the government’s plans to introduce a ban on smoking in public places are becoming increasingly discussed. If the project is implemented, the law on the protection of youth can also be adjusted.

https://p.dw.com/p/8u5C

Last puff? Photo: AP Advertisement

The German government is studying the possibility of tightening the youth protection law. As stated in the Ministry of Consumer Protection, we are talking about selling cigarettes to young people not from 16, but from 18 years old. “This consideration arose in the light of the current public debate about a ban on smoking,” explained Bundestag State Secretary for Consumer Protection Gerd Müller.

Trade – against

Representatives of German trade have already expressed their opposition to the tightening of the law. So the Union of German Hotels and Catering Enterprises (Deutsche Hotel- und Gaststättenverband – DEHOGA) opposed the initiative of the head of the Ministry of Consumer Protection Horst Seehofer about a general ban on smoking in restaurants.

As union manager Ingrid Hartges said in an interview with the Neue Presse newspaper: “We are responsible for achieving the agreed goal of protecting non-smokers and we expect the government to stick to the treaties.”

According to Hartges, food service companies should have until March 1, 2007 to show that they can expand their non-smoking program without being mandated by law.

At one time, the “red-green” government concluded an agreement with the union on the protection of non-smokers, which provides for a phased solution to this problem. After the deadline, from the beginning of March 2007, about half of the places in public places should be provided for non-smokers.

In addition, Hartges demanded that companies, while retaining as much discretion as possible, should be able to formulate their offers in such a way that both smokers and non-smokers feel welcome.

The bill is still quite crude

Consumer Protection Minister Horst Seehofer is currently investigating the legal possibilities of introducing a ban on smoking in catering establishments and public places. “There is already a rough draft law,” said ministry state secretary Gert Lindemann.

According to the ministry, the limits of a possible ban have not yet been discussed. It has also not been decided whether smoking will be banned in public institutions, as well as universities and schools.