Smoking and Heartburn: Why It Makes Symptoms Worse

Lighting up a cigarette might feel like a quick stress relief. But it could be fuelling something more uncomfortable: heartburn. This burning sensation occurs when acid from the stomach rises up into the oesophagus. Repeated episodes are a sign of gastroesophageal reflux disease (GERD).

While greasy meals and alcohol are well-known culprits, smoking is often overlooked. It doesn’t just irritate your lungs and increase your risk of cancer; it also weakens your digestive defences.

Visit our symptoms page to learn more about heartburn.

So, how exactly does smoking make heartburn worse? And what’s the real connection between the two? Let’s take a closer look.

How Heartburn Works

Heartburn occurs when acid from the stomach enters your food pipe (oesophagus), causing a severe burning sensation. It’s normal, occasionally. However, repeated episodes of heartburn are often triggered by an underlying cause.

Usually, the lower oesophageal sphincter (LOS), which separates the stomach and oesophagus, prevents backflow. But if it becomes relaxed or the stomach pressure is too great, it can be overcome.

The primary difference between occasional heartburn and GERD is that in GERD, acid attacks happen frequently, often several times a week.

The Effect of Smoking on Heartburn

Why does smoking affect your stomach?

It seems strange, right? Well, the effects of cigarettes aren’t confined to your lungs. The harmful chemicals and carcinogens — alongside nicotine — enter your bloodstream. From there, the nicotine causes the LOS to relax, allowing stomach acid to rise.

In addition, smoking reduces saliva production, which contains bicarbonate to neutralise the acid. Taken together, these effects compound to increase the risk of an acid attack.

Other factors include:

• Slowed gastric emptying, increasing pressure in the stomach

• Irritation of the oesophageal lining

• Increased abdominal pressure through chronic coughing

Does Smoking Make Heartburn Worse? Yes, - and Here’s Why

Smoking doesn’t just trigger heartburn; it makes your existing symptoms worse. It weakens your body’s natural countermeasures, from relaxing the LOS to delaying stomach emptying.

But these effects are also cumulative.

Repeatedly smoking puts your body into a pro-inflammatory state. Inflammation is closely linked to GERD as well as pre-cancerous conditions like Barrett’s oesophagus, where persistent acid exposure causes cellular changes in the oesophageal lining.

Then, there’s the cough. The so-called ‘smoker’s cough’ occurs in long-term smokers. This increases your abdominal pressure, overpowering your LOS and forcing acid upwards. It’s just one more contributing factor.

Can Quitting Smoking Prevent Heartburn?

Yes. Despite online rumours stating that quitting smoking makes GERD worse, the reverse is true. A study of 141 former smokers revealed that 43.9% of participants reported fewer GERD symptoms after one year of quitting. In comparison, the control group of smokers saw no change in reflux symptoms.

That being said, don’t expect the change to occur overnight. It takes a little time for your body to filter out all the harmful chemicals. However, you should see improvements — even if mild — within a week or so.

How to Relieve Heartburn

So, there’s a clear connection between smoking and heartburn. But how do you relieve these symptoms?

Follow these tips:

• Don’t Try Nicotine Alternatives. People often rely on nicotine substitutes when they quit smoking. Think patches and gum. The problem is that these provide a constant release of nicotine. That’s actually more likely to trigger acid attacks than smoking.

• Avoid Other Triggers. If you’re continuing to smoke, you should at least minimise other triggers, e.g., avoid fatty foods, limit alcohol intake, don’t eat just before bed, and keep your head elevated when you sleep.

• Have Preventive Medication. There are two main types of medications: relief and prevention. Antacids are the only relief medication, neutralising the acid causing the attack. H2 blockers (e.g., ranitidine) and proton pump inhibitors (e.g., lansoprazole) will reduce acid production, providing long-term prevention.

Quitting smoking is, of course, the best path forward. It can be very difficult, but it doesn’t have to be. In the UK, free local stop-smoking services are available throughout the country, offering evidence-based treatments like medications, nicotine replacement therapy, and personalised quit plans.

For some, finding the right exercise can also help manage heartburn by promoting healthy digestion and maintaining a healthy weight.

You can also ring 0300 121044, the Smokefree National Helpline, for further support.

Get a Full Diagnosis for Heartburn Symptoms

Still struggling with persistent heartburn, even after quitting smoking or making lifestyle changes? It could be a sign of something more complex, like GERD or an underlying motility disorder.  

The Functional Gut Clinic specialises in advanced diagnostic testing to get to the root of reflux, heartburn, and digestive discomfort. Book a consultation today and take the next step towards lasting relief.