The Heartburn-Tobacco Connection

There are many good reasons to quit smoking. They range from curing your bad breath to reducing your risk of cancer, heart disease, and lung disease. But here's another reason to add to that long list: tobacco -- not just in cigarettes, but in cigars, pipes, chew, and snuff -- can cause heartburn.

"Tobacco makes acid reflux worse," says David Carr-Locke, MD, director of endoscopy, Brigham and Women's Hospital, Boston. "It's definitely a risk factor."

And unlike a heightened risk of serious diseases -- which might seem rather abstract, especially when you're young -- heartburn is a consequence of tobacco use that you can feel right now. And chronic heartburn, due to gastroesophageal reflux disorder (GERD), can cause more than serious pain; it can disrupt your sleep and interfere with your life.

Healing the Heartburn

According to some experts, there's a simple solution to the heartburn/tobacco equation, although you've probably heard it before: quit. "For some people, quitting tobacco use can be the difference between having GERD and not having it," says Lawrence J. Cheskin, MD, co-author of Healing Heartburn and associate professor at Johns Hopkins School of Medicine in Baltimore. "If you stop, your symptoms will probably get better quickly. It also really lowers the risks of having further complications down the road." However, not everyone thinks that quitting tobacco use will necessarily have a dramatic effect on heartburn.

"I think that quitting only has a modest impact on GERD symptoms,” says J. Patrick Waring, MD, a gastroenterologist at Piedmont Hospital in Atlanta. But he still strongly encourages anyone who uses tobacco to kick the habit.

How Does Tobacco Affect GERD?

When you eat, a muscular ring between the end of the esophagus and the entrance to the stomach -- called the lower esophageal sphincter (LES) -- relaxes to let food in. Once it has closed again, the stomach releases acids and enzymes to break down the food. Usually, these acids stay put in the stomach. But in people with GERD, the sphincter may stay relaxed or relax at the wrong time. This allows stomach contents containing acids and enzymes to wash back up, irritating the tissue of the esophagus.

Experts believe tobacco might worsen heartburn in a number of ways, including:

• Impairing the function of the LES. "The nicotine in tobacco seems to lower the pressure in the lower esophageal sphincter," says Cheskin. The reduced pressure could allow stomach acids and enzymes to back into the esophagus.

• Increasing acidity. Nicotine increases the production of stomach acid, says Carr-Locke.

• Harming the esophagus. Tobacco smoke seems to directly irritate the esophagus lining, says Cheskin.

• Reducing saliva production. This causes two problems. When you swallow, saliva helps push acid down, out of the esophagus and into the stomach. Saliva also contains bicarbonate, which is a mild acid neutralizer, says Cheskin. So a reduction in saliva can make your acid reflux worse.

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