Why Tobacco Use May Make Heartburn Worse

From the WebMD Archives

You’ve cut out the pizza and chili dogs, lost weight, and raised the head of your bed. But your heartburn just won’t go away. Before you reach for a new bottle of antacids, you can do one more thing that might help: Quit smoking.

A large study found that smokers were much more likely than nonsmokers to have acid reflux, a condition that causes acid from the stomach to leak upward into the esophagus, the tube that food travels through. A tell-tale symptom of acid reflux is heartburn -- that burning feeling in your chest. Smoking also sometimes goes hand in hand with other habits, like drinking coffee or alcohol, that are thought to fire up the burn in your body. But cigarettes alone can bring on the discomfort.

Cigarettes: The Heartburn Connection

Nicotine, a key part of tobacco, is thought to relax the ring of muscle in the lower esophagus that keeps acid in the stomach, where it belongs. When that ring relaxes, acid can trickle up and cause that burning sensation.

Smoking can also cause your mouth to make less spit, which might mean more heartburn symptoms. When reflux happens, acid gets into the lower part of the esophagus, says Ronnie Fass, MD. Saliva offsets the acid. Fass is director of the division of gastroenterology and hepatology at MetroHealth Medical Center in Cleveland. Cigarettes may also make it harder for your body to make a substance that helps guard you from stomach acid.

A smoker’s cough won’t help you, either. “Each time you cough you get increased reflux because you’re increasing your abdominal pressure,” says Rahul Pannala, MD. That pressure sends acid upward. Pannala is an assistant professor medicine at Mayo College of Medicine.

Chewing Tobacco, Nicotine Gum, and Patches

“Chewing tobacco is even worse,” Fass says. Because nicotine is released constantly, it could mean more heartburn.

Nicotine gums and patches are safer bets for overall health than chewing or smoking tobacco, and they are less likely to give you heartburn. "Chewing gum may have some positive effect, and nicotine gum is likely a better choice than smoking cigarettes," Pannala says. One small study found no increase in heartburn risk in people who used a nicotine patch.

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Good Reasons to Quit

There’s no guarantee that quitting will get rid of your heartburn, but it’s worth a try, especially given the other well-known health dangers of smoking.

If you're overweight, you may want to shed some pounds, too. A recent study of smokers with severe acid reflux symptoms found that quitting only helped those who weren’t overweight. If your body mass index (BMI) is outside the healthy range, Fass says, “quitting tobacco is not enough. You have to also lose weight.”

“The act of quitting or trying to quit tends to lead to healthier habits,” Pannala says. These include eating a more balanced diet and limiting how much alcohol you drink, both of which could help with heartburn symptoms. “It sounds simple, but it can make a difference.”

WebMD Feature Reviewed by Arefa Cassoobhoy, MD, MPH on March 13, 2014

Sources

SOURCES:

Nilsson, M. Gut, December 2004.

Rahul Pannala, MD, assistant professor medicine at Mayo College of Medicine.

Ronnie Fass, MD, director of the division of gastroenterology and hepatology and head of the esophageal center at MetroHealth Medical Center.

Ness-Jensen, E. American Journal of Gastroenterology, February 2014.

Wright, RA.Nicotine & Tobacco Research, December 1999.

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