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Smoking and Heartburn

  

Despite evidence of related health hazards, not to mention ubiquitous "No Smoking" signs, nicotine continues to hold millions in its addictive grip. More than one fourth of the adult American population smokes cigarettes, cigars, or pipes.¹

While smoking causes a variety of damaging effects on the whole body, it is particularly destructive to the upper airway and the digestive system.^{1, 2}

Current research on smoking and heartburn

Early medical reports began characterizing the negative effects of smoking as early as 1859, describing patients with oral tumors.¹ While the relationship between smoking and various lung diseases, like emphysema, has long been established,³ clinical studies now link smoking to digestive diseases as well.^4-7

Smoking damages the digestive system

Studies indicate that smoking relaxes the lower esophageal sphincter (LES). When the LES relaxes or is not functioning properly, acidic stomach juices can reflux into the esophagus, which results in the sensation known as heartburn.

One report showed that esophageal acid exposure increased by over 50 percent after smoking. Interestingly, heartburn episodes were more frequent - 114 percent more likely to occur - during the daytime when sufferers were standing upright. (Typically the force of gravity works in heartburn sufferers' favor during the day.)

Other studies have shown that smoking has harmful effects on salivary function that result in a longer than normal time to remove or "clear" the esophagus of any acid.^1,8 The longer it takes for acid to be cleared, the more damage can occur. Notably, other reports contend that smoking changes the composition of the saliva, which normally contains acid-neutralizing chemicals known as bicarbonates. Smokers' saliva contains markedly smaller amounts of bicarbonates, thus reducing the ability of the saliva to neutralize stomach acid that can damage esophageal tissues.^5,8

Inconclusive Research

While most medical professionals acknowledge the link between smoking and heartburn, not all research in this area is conclusive. A recent study on the management of gastroesophageal reflux disease (GERD) failed to demonstrate that quitting smoking would have a significant impact on the development of GERD.⁹

Wide-ranging bodily effects are potentially serious as well

Smoking has been shown to cause an overall level of "digestive stress" that may alter the way in which food is digested and processed.² In addition, the liver may be damaged by smoking, causing this vital organ to not process drugs and alcohol in normal ways.²

What can be done to reduce smoking-related heartburn?

Because smoking diminishes the natural protective ability of saliva, increases the rate of heartburn episodes, and increases the acid clearance time from within the esophagus,⁵ any amount of smoking can further increase your chances of developing heartburn.
However, moderating your tobacco intake can limit the severity and duration of heartburn symptoms triggered by smoking.

Here are a few tips to try if you experience smoking-related heartburn:

• Keep track of when heartburn hits and the specific activities that seem to trigger the incidents. (See our personal reflux diary to help identify what triggers your attacks.)
• If your aim is to unwind after a stressful day, try exercise, walking, meditation,
  stretching, or deep breathing instead of smoking.
  
• Work toward adopting a healthier lifestyle.
• Stop or decrease smoking.

References:

1. Fitzpatrick TM, Blair EA. Upper airway complications of smoking. Clin Chest Med 2000; 21:147-57.
2. Smoking and your digestive system. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases, 1991.
3. Average annual number of deaths, 1990 -1994. CDC, MMWR, Mar. 3 1999; 48; 131-38
4. Kadakia SC, Kikendall JW, Maydonovitch C, Johnson LF. Effect of cigarette smoking on gastroesophageal reflux measured by 24-h ambulatory esophageal pH monitoring. Am J Gastroenterol 1995; 90:1785-90.
5. Kahrilas PJ. Cigarette smoking and gastroesophageal reflux disease. Dig Dis 1992; 10:61-71.
6. Kahrilas PJ, Gupta RR. Mechanisms of acid reflux associated with cigarette smoking. Gut 1990; 31:4-10.
7. Waring JP, Eastwood TF, Austin JM, Sanowski RA. The immediate effects of cessation of cigarette smoking on gastroesophageal reflux. Am J Gastroenterol 1989; 84:1076-8.
8. Trudgill NJ, Smith LF, Kershaw J, Riley SA. Impact of smoking cessation on salivary function in healthy volunteers. Scand J Gastroenterol 1998; 33:568-71.
9. Dent J, Kahrilas RJ, Talley NJ. Management of gastroesophageal reflux disease in general practice. British Medical Journal; 2-10-01