Most, but not all, studies show that smoking has a negative effect on LES pressure, and perhaps more importantly, diminishes the concentration of salivary bicarbonate. This latter factor indirectly could be extremely important in view of data that have shown that reducing salivation will markedly retard esophageal acid clearance and, conversely, enhancing salivation will facilitate acid clearance. In view of epidemiological data suggesting a relationship between smoking and AC of the distal esophagus, and the overall negative health consequences of smoking, a strong recommendation to stop smoking would be advisable for GERD patients.

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