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!