Cigarette smoking has been linked to an increase in symptoms of gastroesophageal reflux, such as heartburn and acid regurgitation.

But what is the connection between smoking and reflux?

It’s fair to say that there are several theories, so let’s look at some of the more frequently made claims.

“It’s the nicotine”

It has been suggested that nicotine, the chemical stimulant in tobacco, relaxes the lower oesophageal sphincter – the valve between the stomach and the oesophagus. A weak stomach valve enables stomach contents to travel back into the oesophagus.

In 1972, researchers found that ‘smoking a cigarette invariably caused a fall in sphincter pressure’ among patients. While a 1990 study identified cigarette smokers had significantly lower oesophageal sphincter pressure compared with non-smokers, although the sphincter was not further compromised by acutely smoking cigarettes.

“Smoking stops you salivating”

Some studies suggest smoking means you produce less saliva – more specifically, it reduces ‘salivary bicarbonate secretion’.

Reduced salivation during or immediately before sleep has been linked to increased reflux symptoms. Saliva has also been found to protect oesophageal mucosa against refluxed gastric contents.

“It can stop you swallowing effectively”

Smoking is said to adversely affect stimulation of the pharyngo-UOS contractile reflex and pharyngeal reflexive swallow – according to a 1995 study. These reflexes enhance the physical barriers against entry of refluxate into the throat.

“Smoking damages the oesophagus”

Tobacco smoke contains toxins and chemicals that can irritate the cells that make up the lining of the oesophagus, which can increase the chances of cancer. An estimated 66 per cent (63 per cent in males and 71 per cent in females) of oesophageal cancers in the UK are also linked to tobacco smoking.

“Smoking slows digestion”

Studies have shown that smokers have decreased gastric motility (digestion) which means the stomach takes longer to empty.

“Smoking decreases the production of bicarbonate”

Bicarbonate is an important substrate that contributes to various metabolic reactions such as the biosynthesis of fatty acids/ Smoking decreases the production of bicarbonate, a substance that neutralises stomach acid, by damaging the cells in the stomach that produce bicarbonate. This can lead to an increase in stomach acid and make symptoms of acid reflux, such as heartburn, worse.

So what about vaping or pipes?

Vaping is the act of inhaling vapor produced by an electronic cigarette or similar device. The vapor typically contains nicotine, flavourings, and other chemicals.

Limited studies have been conducted to determine the effects of vaping on GERD. However, some evidence suggests that inhaling vapor may irritate the airways and trigger symptoms of GERD, such as heartburn and acid reflux.

A 2017 study found an association  between waterpipe smoking and severe and frequent reflux. The associations increased with the duration of use, intensity and cumulative waterpipe-years.

In summary

Smoking has been shown to increase the risk of developing gastroesophageal reflux disease in multiple studies.

Smoking has several effects on the body that contribute to GERD, including relaxing the lower oesophageal sphincter, decreasing production of saliva which helps to neutralise stomach acid, and increasing the production of stomach acid.

Additionally, smoking can irritate the oesophagus and increase inflammation, further contributing to GERD symptoms. Quitting smoking can help reduce the risk of developing GERD or improve symptoms for those who already have the condition.

A 2015 study revealed that stopping tobacco smoking led to reflux symptoms improving from ‘severe’ to ‘no or minor complaints’ in a group of patients.

Although research on how exactly reflux and smoking are connected is not conclusive, it’s safe to say that smoking is harmful.

Approximately 79,000 people in the UK die due to smoking every year. This accounts for nearly one in six deaths in the country and is the leading cause of preventable death.

Not smoking can also lead to:

  • Improved lung health
  • Better cardiovascular health
  • Better oral health
  • Improved reproductive health
  • Reduced risk of cancer
  • Better overall health

Updated Feb 2023

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