Symptoms

Dr. Eisner Answer your GERD Questions: Does Smoking Cause Acid Reflux?

Todd Eisner Health Guide April 29, 2008

    I have been experiencing a lot of acid reflux of late. I think it might have something to do with the fact that I've been smoking more lately. Is this true?

     

    There are many reasons to not smoke, and one of the reasons is that it can definitely cause or worsen symptoms of esophageal reflux disease. First off, tobacco inhibits saliva, which is a significant buffer that the body has against acid. Secondly, studies have shown that tobacco can stimulate the production of stomach acid production. Lastly, and most significantly, tobacco causes a relaxation of the lower esophageal sphincter muscle, thereby allowing acid reflux from the stomach to the esophagus to occur.

     

    I wake up every morning coughing. I have been to my internal medicine doctor, an ear nose and throat doctor and pulmonologist and have not gotten better. A friend told me that they had a cough that was related to reflux. How can I tell if that is the cause of my cough? 

     

    Chronic cough, sore throat, laryngitis with hoarseness and frequent throat clearing can be due to acid reflux. There are a few mechanisms for how this occurs. First off, acid that refluxes up the esophagus can irritate the back of the throat, causing a sore throat, hoarsenesss and cough. Secondly, as the acid comes up the esophagus, as the esophagus lies next to the trachea, there can be irritation of the nerves and muscles of the esophagus that can react with the nerves and muscles of the trachea, making them hyperactive and causing a cough. Finally, small amounts of regurgitated acid can get to the back of the mouth, and fall into the trachea, irritate the bronchi and lungs equivalent to a micro-aspiration. Frequently, treatment with medications used to treat acid reflux will help. At times however, patients need to be treated with twice the dose of such medications and frequently for at least 2-3 months before symptomatic improvement is noted. You should check with your doctor as to whether further investigation to the etiology of your cough with a gastroenterologist is warranted.

    I have been to the emergency room 3 times in the past month with chest pain. Each time I am admitted because of the fear that it is my heart. My internist says that it is not acid reflux as I had a normal endoscopy in the past year, but I am suspicious that it might be as antacids seem to help. What can I do?

     

    First of all, you need to make sure that you are adhering strictly to all of the lifestyle modifications of gastroesophageal reflux disease. You need to lose weight if necessary, not smoke, not drink and not eat foods that typically cause acid reflux such as caffeine, chocolate and peppermints. You need to not eat late at night, and not lie flat within three hours after eating. You should check with your doctor about staying on a medication that lowers acid for at least a few months to see if the symptoms abate. If all fails, you need to be referred back to your gastroenterologist. It is not unusual for someone to have symptoms of acid reflux and have a normal endoscopy. He may want to do other tests, such as a pH study of your esophagus to rule out gastroesophageal reflux, or an esophageal manometery to look for other esophageal causes of chest pain such as esophageal dysmotility, esophageal spasm or achalasia. Finally, other non-cardiac or non-esophageal causes of chest pain need to be considered as well. It can be very scary having chest pain, as people usually think that it is coming from the heart. Check with your doctor about what the next step in your evaluation should be.