• Jasmine Blake, MS, HHP

Can Smoking Cause Gastrointestinal Dysfunction?

Updated: Mar 31

What Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is a condition also known as GERD or Acid Reflux. "It is a condition that develops when there is a backflow of stomach contents causing symptoms or complications [1]. In other words, stomach contents are backing up into the esophagus. Signs and symptoms of GERD are belching, heartburn, nausea, regurgitation, pain in the abdomen, and discomfort or fullness. The mucosa is the innermost lining of the throat area and gastrointestinal tract where most of the symptoms and signs can be identified. Also, GERD can become apparent when changes in the tissue lining of the esophagus occur, or mucosal injury begins evolving. 


Why does Reflux Occur?


Mucosal injury can happen for many reasons. In GERD, the lining changes because of the stomach acids and undigested food contents that are being pushed out of the stomach upward, and this aggravates the lining. The ingested foods or fluids being pushed up result in an unbalance of pressure in the stomach. Several reasons can cause this pressure to happen, and one is eating excessive amounts of food. It can also be caused by food sensitivities, alcohol, Hiatal Hernia, esophagus muscle weakness, and repeated ingested drug abuse. [7].


Although pressure is a common cause of GERD, it is good to note that there is a natural pressure in the stomach. If the pressure is reduced, enhanced, or unbalanced in any way, it can cause the many complications we identify as GERD signs and symptoms. In addition, smoking is a common cause that results in a fluctuation in pressure, which is directly related to GERD. [5].


Smoking and Acid Reflux


According to Kahrilas et al (1990), smoking can cause acid reflux, and it has been observed to lower the pressure of the esophageal spinster. [5]. Although smoking is directly related to gastrointestinal dysfunction, most people do not understand how this process can happen. Part of it is because of the oxidative stress that occurs when inhaling tobacco. [5]. However, there is more to the biochemistry than just knowing smoking causes oxidative stress, and how smoking causes GERD should be adequately explained.


When smoking cigarettes or tobacco, people are technically inhaling a toxic substance or chemical into their lungs. In fact, anything other than oxygen being inhaled into the lungs is considered toxic to the body. The purpose of the lungs is not just to breathe oxygen into the body through airways, but its job is to bind it with the hemoglobin protein in the blood. [4].


The Airways


Then, the blood transports the mixture throughout the bloodstream to all the cells and parts of the body. In exchange, the lungs will exhale carbon dioxide (CO2) out of the airways.[4]. Naturally, the body can protect these airways to ensure that no other foreign substances enter this pathway. When smoking nicotine, it is absorbed into the blood via the lungs, which circulates throughout the body as well.


The airways used to breathe in oxygen and breathe out CO2 are the same airways directly connected to the upper esophageal sphincter (UOS). [3]. The UOS muscle has natural reflexes throughout this pathway and can open or close when necessary. The pharynx is directly affected through this pathway also.


What is the Pharnyx?


The pharynx is the membrane-lined cavity behind the nose and mouth that connects to the esophagus. It is a common channel for swallowing and respiration. It is also considered part of the digestive system. [8]. As well, the same pathway used for breathing is triggered to cause the pharyngeal airway closure also because the food and air pathways cross each other in the pharynx. [8]. As a result of the pharyngeal airway closing, it contracts the UOS to open. 


It should be noted that the pharynx and UOS are both connected with the same pharyngeal sensory nerve. In fact, the chief action in which the muscles of the pharynx combine is swallowing. This is a complicated neuromuscular act whereby food is transferred from the mouth through the pharynx and the esophagus to the stomach. [8].


When smoking, the function of the sensory nerve endings that control the opening and closing of the pharynx and UOS become damaged. [3].The destruction of the pharyngeal sensory nerve endings happens because of free radicals that are accumulated into the mucosal layer by inhaling smoke constantly. [3]. When nerve endings become impaired, it causes injury to the lining of the pharynx. [3]. In turn, the damages of the lining of the pharynx directly relate to the delaying of gastric actions.


The Suspension of Gastric Actions


The suspension of gastric actions is due to the temporary suspension of pressure. How this relates to the destruction of the lining of the pharynx is because the suspension of pressure causes less lower esophageal pressure over time. [5]. As pressure decreases, this causes the contraction and relaxation of esophageal muscles. [5]. In addition to the UOS and the pharynx becoming damaged, the mucosa of the lower esophageal sphincter gets damaged as well.


The oxidative stress that occurs here is what causes the slowing of gastric flow, which can create additional gasses that can cause fluctuations in pressure. [3]. Furthermore, the pressure usually is only suspended during the actual act of smoking and not suspended when not smoking. [5]. However, after repeated smoking of tobacco products over time, this mechanism begins to have adverse effects and pressure suspends repeatedly resulting in GERD.


Ways to Heal GERD


In dealing with GERD, it is hard to understand the mechanisms of the condition and what it takes to heal. Below are six alternative options listed to assist with assessing and treating symptoms of GERD. Several reasons can cause GERD. Evaluating for the following reasons can help rule out why GERD is occurring:


  1. A great for assessing GERD could be to administer an Endoscopy. This will be to see if there is inflammation occurring before opting to take anti-inflammatory supplements. If GERD is apparent, the first alternative treatment option is to administer the best nutritional, herbal, or over-the-counter supplement to treat this condition. The treatment plan should pertain to the client's bio-individual fingerprint.

  2. If the first option is not found to be a sufficient reason for assessing and treating GERD; then a second way to evaluate the client would be to rule out Hiatal Hernia. This assessment is completed through the Barium Swallow diagnostic measure. Hiatal Hernia can cause severe pressure in the stomach affecting the lower and upper reflexes. If GERD is identified, then alternative treatment options would be similar; administer the best nutritional, herbal, or over-the-counter supplement to treat this condition.

  3. If neither inflammation nor Hiatal Hernia is apparent, then the third type of assessment could be to use Esophageal Manometry. This assessment is used to test the strength of muscles in the esophagus and stomach to ensure they are working correctly. If they are not working correctly, food and fluids can be pushed up through the UOS. Again, if GERD is identified, then alternative treatment options would be similar; administer the best nutritional, herbal, or over-the-counter supplement to treat this condition.

  4. A fourth alternative to assessing and treating GERD could be a lifestyle change plan that includes Smaller Meals. Large meals are known to interfere with the pressure in the stomach. Large meals are also too complicated to digest. Eating this way can upset the pressure of the stomach and cause fluctuations in the reflex muscles of the UOS. This treatment plan will aid in the stomach digesting the food more accurately, and by having less food in the stomach, less will likely to come up and cause irritation.

  5. In addition to smaller meals, Ginger Tea is a great fifth alternative to treating GERD. This tea will help GERD from occurring by drinking through the day. Plus ginger is used to increases HCL in the stomach. Increasing HCL will help break down foods properly and help relieve some symptoms of GERD. [2].

  6. As the sixth option, Artichokes would be a good alternative for treating GERD. The leaves can be boiled and scraped. The vitamins and minerals within this plant can be slow-cooked out. Artichokes are known to increase gallbladder production by increasing Choleretic activity and enhancing the elimination of lipids and bile acids. With the ease of digestion, this can help alleviate some symptoms of GERD. [9].


Conclusion


In conclusion, smoking is a direct correlation in causing GERD. You can reduce the risk of getting GERD and reverse symptoms by eliminating smoking. Also, food habits and the way we eat are a significant contributing factor to GERD. Anything that affects the pressure of the upper esophageal sphincters or lower esophagus can cause GERD as well. Things that affect the balance of pressure can be repeated ingested drug abuse, food sensitivities, alcohol, Hiatal Hernia, and esophagus muscle weakness. If the pressure is controlled, with alternative treatment options, and change of lifestyle, then GERD can be reversed.

References:

  1. Antunes, C., & Curtis S. A. Gastroesophageal Reflux Disease. (2019) In: StatPearls [Internet]. Treasure Island (FL): StatPearls.  Retrieved  from: https://www.ncbi.nlm.nih.gov/books/NBK441938/ (Links to an external site.)

  2. Bode, A. M., Dong, Z., (2011). Herbal medicine: Biomolecular and clinical aspects, (2nd Ed.). In Chapter 7: The amazing and mighty ginger. Boca Raton, FL: CRC Press/Taylor & Francis. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK92775/ (Links to an external site.)

  3. Dua, K., Bardan, E., Ren, J., Sui, Z., & Shaker, R. (2002). Effect of chronic and acute cigarette smoking on the pharyngoglottal closure reflex. Gut, 51(6), 771–775. doi:10.1136/gut.51.6.771

  4. How the Lungs Work. (n.d.). National Heart, Lung, and Blood Institute.  https://www.nhlbi.nih.gov/health-topics/how-lungs-work (Links to an external site.)

  5. Kahrilas, P. J., & Gupta, R. R. (1990). Mechanisms of acid reflux associated with cigarette smoking. Gut, 31, 4-10.

  6. Konrad, H. R., Rattenborg, C. C., Kain, M. L., Barton, M. D., Logan, W. J., & Holaday, D. A. (1984). Opening and closing mechanisms of the larynx. Otolaryngol Head Neck Surgery Journals, 92(4):402-5.

  7. Kneesi, R. (2019). NUTR635, Module 6 [Resources]. Retrieved from Lecture Notes Online Web site https://www.muih.edu

  8. O'Rahilly, R., Müller, F., Carpenter, S. & Swenson, R. (2008). Basic human anatomy: A Regional Study of Human Structure. Dartmouth Medical School.

  9. Saénz Rodriguez, T.,  García Giménez, D., & de la Puerta Vázquez, R. (2002). Choleretic activity and biliary elimination of lipids and bile acids induced by an artichoke leaf extract in rats. Phytomedicine, 9(8), 687-93. https://www.ncbi.nlm.nih.gov/pubmed/12587687 (Links to an external site.)

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