Electronic cigarettes are popular yet the medical industry is just beginning to learn about the side effects of their use.1 From a cursory review of e-cigarette forums and social media platforms, a potential association between vaping and heartburn is found.2
With e-cigarette users voicing concern about a connection between vaping and heartburn (a symptom of acid reflux), a detailed study into the connection between vaping and gastroesophageal reflux disease (GERD which is chronic acid reflux) is warranted.
Anyone using e-cigarettes who has experienced a connection between vaping and chronic heartburn should speak with a gastroenterologist. Discontinued use may be advantageous for preventing a progression of disease from GERD to Barrett’s esophagus, a precancerous condition of the esophagus that develops into esophageal cancer when left untreated.3
- 8 Ways Nicotine Increases Heartburn
- What Causes Acid Reflux?
- Heartburn: Causes, Prevention, Treatment
- GERD: Symptoms, Causes, Prevention, Treatment
Why Does Vaping Cause Heartburn?
There are side effects of e-cigarette use that can lead to acid reflux and heartburn. They are very similar to smoking cigarettes.4 These side effects are irritation of the esophagus and the relaxation of the lower esophageal sphincter (LES).
If you’re not familiar with the cause of heartburn it’s generally due to irritation after stomach acid has come in contact with the esophageal lining. The LES is a valve that opens when you swallow and closes afterward to keep stomach contents in place. When the LES is relaxed or isn’t closing properly, acid can pass back up through the LES into the esophagus. This is acid reflux.
Let’s look at the different aspects of vaping that can potentially lead to esophageal irritation and the relaxation of the LES.
1) Relaxation of the Lower Esophageal Sphincter (LES) Caused by Vaping
Nicotine causes the LES to relax. A relaxed LES allows stomach acid to leak back into the esophagus causing heartburn.
2) Vaper’s Cough Caused by E-Cigarettes
Most people who use e-cigarettes cough while vaping.2
When you cough, your diaphragm contracts. This places pressure on the stomach which pushes food upward and possibly through the LES into the esophagus.
In other words, coughing can cause stomach acid to reflux into the esophagus and thus cause heartburn.
3) Irritation and Inflammation of the Esophagus Caused by E-Cigarette Use
Smoke, nicotine, and e-liquids can potentially irritate the esophagus and cause inflammation. The irritated state of the esophagus will cause greater sensitivity to any stomach acid that comes in contact with the esophagus.
4) Allergy to E-liquid Components
Allergic reactions to e-liquid components such as propylene glycol (PG), vegetable glycerine (VG), and flavor extracts could lead to heartburn. An allergic reaction could potentially cause both esophageal irritation and LES relaxation.2
5) Damage to the Esophagus Caused by E-Cigarette Use
The esophagus has a mucous membrane that acts as a protective barrier. This lining helps protect your esophagus when acid is refluxed.
Nicotine damages the mucous membrane that lines your throat making damage from acid reflux more likely.
E-liquids without nicotine could potentially cause this damage as well. Additional studies need to be done to determine if there is a correlation between nicotine-free e-liquids and damage to the esophageal lining.
6) Low Saliva Production from Vaping
Nicotine use lowers the production of saliva. A lack of saliva can potentially increase the risk of heartburn.
Saliva reduces your chance of heartburn by removing and neutralizing stomach acid.
- When saliva is swallowed it washes refluxed acid back into the stomach where it belongs. This process can potentially reduce the possibility or duration of heartburn by reducing acid contact time with the esophageal lining.
- Saliva contains bicarbonate. This is the same component of baking soda that works as an antacid.5
7) Changes in Stomach Acid Production Caused by E-Cigarette Use
Nicotine in e-cigarettes increase stomach acid production and can also cause bile salts to move from the intestine to the stomach. This increase in acid will cause acid reflux side-effects like heartburn to be more intense.
The e-liquid flavors may also increase stomach acid production. The increase in acid is created to break down the food your stomach thinks you’re about to send it.
8) Slowed Digestion from Vaping
Nicotine slows the digestive process. This increases the possibility of acid reflux and potentially the intensity of heartburn pain.
- Slowed digestion increases food volume in the digestive tract and thus pressure on the LES which can lead to acid reflux.
- Slowed digestion also increases stomach acid production to down food sitting in your stomach. If this acid refluxes into the esophagus, the higher acid levels can cause increased esophageal irritation.
A lot of research into e-cigarette use and vaping’s effect on health is underway. The results of these studies will be slow coming but will likely confirm general public suspicion that e-cigarettes are unhealthy for a vast number of people.
The smoke, e-liquid components like nicotine, propylene glycol (PG), vegetable glycerine (VG), flavor extracts, and others including CBD and THC can all contribute to heartburn and GERD. Even the wattage of e-cigarettes has been noted by users to be a contributing factor in developing heartburn.6
Anyone using e-cigarettes who has experienced a connection between vaping and chronic heartburn should speak with a gastroenterologist.
- Smoking & Tobacco Use: Electronic Cigarettes. Centers for Disease Control and Prevention.
- Qiudan Li, Yongcheng Zhan, Lei Wang, Scott J. Leischow, and Daniel Dajun Zeng. Analysis of Symptoms and Their Potential Associations with E-Liquids’ Components: A Social Media Study. BMC Public Health Published online 2016 Jul 30.
- O. Pech. Screening and Prevention of Barrett’s Esophagus. Visceral Medicine. 2019 Aug;35(4):210-214.
- Smoking and the Digestive System. The National Institute of Diabetes and Digestive and Kidney Diseases, September 2013.
- R. Moazzez, D. Bartlett, and A. Anggiansah. The Effect of Chewing Sugar-Free Gum on Gastro-Esophageal Reflux. Journal of Dental Research. 2005 Nov;84(11):1062-5.
- Side Effects of Vaping. Vaping Daily. Published: April 21, 2017 Updated: April 5, 2019