Vaping Linked to Increased GERD Symptoms

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Vaping and smoking, male gender and higher body mass index (BMI) were significant risk factors influencing gastroesophageal reflux disease (GERD) symptoms among a group of university students, leading investigators to push for public health initiatives to reduce smoking and electronic cigarette use as well as to increase awareness about GERD risks.

The connection between smoking and GERD has been established, with nicotine considered the main etiological cause, as it relaxes the smooth muscle of the lower esophageal sphincter. Smoking also raises the amount of stomach acid and increases acidic secretions, which are both linked to an increased risk of esophageal injury. Although vapes have been marketed as a healthier alternative to traditional cigarettes, they mix nicotine, vegetable glycerin and a number of potentially dangerous ingredients that are heated to generate an aerosol.

“The use of vaping among teens and young people has recently surged in Saudi Arabia and around the world due to a lack of information about the health consequences of e-cigarettes and advertisements that promote e-cigarettes as healthier than traditional smoking,” noted the team of investigators from Al-Maarifa University in Diriyah, Saudi Arabia.

A cross-sectional study was conducted between July and September 2024 among university students in Riyadh, Saudi Arabia. Students aged 18 years and older were surveyed using an online questionnaire distributed using social media platforms, such as WhatsApp and Telegram. The questionnaire collected demographic information, medical history, smoking behaviors and GERD prevalence using the validated gastroesophageal reflux disease questionnaire (GerdQ).

GERD symptom frequency was categorized into four groups based on their occurrence per week: 0 (zero days), 1 (one day), 2 (two or three days) and 3 (four to seven days). Symptoms were calculated on a scale of 0 to 18, in which higher scores represented more frequent and severe symptoms.

In total, 403 students participated in the study, of which 64.6% (93 students) were diagnosed with GERD, 23.1% smoked tobacco and 43.7% vaped electronic cigarettes. Most participants were male (78.4%), were single (94.5%) and had normal BMI (46.2%).

GERD symptoms included heartburn, regurgitation, pain in the middle of the upper stomach and nausea. Sleeping issues related to GERD and the need for over-the-counter or prescription medication for heartburn or regurgitation were also assessed.

Students who were smokers or vapers had higher GERD symptom scores than nonsmokers, and newer smokers and frequent vapers — defined as four to seven days per week — reported more severe symptoms. Newer smokers may be disproportionately affected due to increased nicotine sensitivity.

Additionally, men reported more GERD symptoms than women, which may be attributed to more male subjects in the sample reporting current smoking or vaping. Overweight and obese participants were more likely to experience severe symptoms than those with a normal BMI, which aligns with previous research demonstrating a link between BMI and an increased pressure on the stomach, which can induce acid reflux.

“The high prevalence of GERD (64.6%) among students with medical issues highlights the importance of understanding the factors that contribute to the condition,” explained investigators. “This prevalence is higher in a similar study conducted in India, where 25% of students experienced GERD symptoms. This difference may be explained by the higher use of e-cigarettes in our sample, as more than 43% of participants reported vaping. This suggests that e-cigarette use might have a stronger link to GERD in our study group.”