I've been told that smoking can cause or trigger heartburn. Is this true?

D.Z.

Cigarette smoking can cause or aggravate many health problems, and gastroesophageal reflux disease (GERD) is one of them. The symptoms of GERD include heartburn, acid regurgitation, chest pain and a sour taste in the back of the mouth.

GERD occurs when stomach acid backs up, or refluxes, into the esophagus. The mechanism that leads to this abnormal reflux involves several potential factors. One is the relaxation of the sphincter separating the esophagus from the stomach. Another potential factor is the presence of a hiatal hernia, in which a portion of the stomach lies above the diaphragm, making it easier for reflux to occur. Finally, poor clearance of refluxed acid from the esophagus may also cause or contribute to symptoms of GERD. Poor clearance may stem from either abnormal muscle function in the esophagus or abnormal salivary function.

Saliva normally contains bicarbonate, a compound that neutralizes stomach acid. Smokers produce up to 50 percent less saliva that nonsmokers. Given those two facts, it's not surprising that studies have found that it takes longer for esophageal acid to clear in smokers, and that GERD symptoms are more common among cigarette smokers.

Interestingly, chronic smokers' bouts of GERD discomfort do not appear to correlate with the specific times when they light up. Thus, abstaining from cigarettes only during the periods when GERD symptoms occur is unlikely to improve a patient's condition. The best approach to relieving smoking-related GERD is to kick the habit entirely.