Wednesday, July 8, 2009

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. Sleeping With Heartburn Carries Cancer Risks.
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.

Only the effects of smoked tobacco have been seriously studied on GERD symptoms, say experts. But anything with nicotine is likely to worsen GERD. Waring says that chew might pose specific problems.

"Smoking a cigarette only takes a few minutes," he says. "But people use chewing tobacco all day. That could lead to more irritation."

By the same token, nicotine gum could also pose a risk, say experts. "I don't know of any studies on nicotine gum and GERD," says Cheskin. "But I would worry that anything with nicotine would increase the risk of acid reflux."

Tobacco use also increases the long-term risks of GERD. Acid reflux is more likely to damage the esophagus in people who use tobacco than in people who don't. The damage will heal more slowly too, Cheskin says. Over time, tobacco users are more likely to face complications of GERD. These include chronic inflammation of the esophagus and even esophageal cancer.
Quitting: Will It Help Your Heartburn?

Cheskin says that cutting out tobacco will almost certainly ease heartburn symptoms.

"I think most people would feel the benefit of quitting within a few days," says Cheskin. He says that it's possible that cutting down your tobacco use -- rather than stopping cold turkey -- might help. But he strongly encourages people to quit.

Yet not everyone is sure that quitting makes a big difference.

"It's true that people with GERD who smoke tend to have symptoms that are more pronounced than people who don't smoke," says Waring. But there isn't good evidence that symptoms improve when people quit using tobacco, he says.

"I think tobacco only plays a minor role in acid reflux," he tells WebMD.

The results of research have been mixed. One 2004 study published in the journal Gut found that smoking tobacco had a strong cumulative effect on GERD symptoms. For instance, the study found that people who smoked everyday for twenty years were 70% more likely to have GERD than those who smoked daily for less than a year.

But a 2006 analysis published in the Annals of Internal Medicine found that while there was a connection between smoking and GERD, quitting didn't necessarily help resolve the symptoms.

So cutting out tobacco use may not cure you. Even if you ditch the cigarettes or chew, you might still have heartburn symptoms. But these may be controlled by other lifestyle changes or medicine.
Getting Control of Your Heartburn

Obviously, quitting tobacco isn't easy. Talk to your doctor about different strategies. You'll certainly need the support of your family and loved ones. You might also consider joining a support group to help you cope.

But just remember that while quitting is tough, you will probably feel a lot better for it. While many people might think of heartburn as an occasional discomfort, people with GERD know how painful and debilitating it can be. Quitting tobacco use could be a first and important step in getting control of your condition.

"If there already weren't enough reasons for you to quit smoking," says Cheskin, "resolving your heartburn is one that you can really feel."



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Cindy Dy said...

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