Cigarette smoking is a known risk factor for both GERD and ulcers of the stomach and duodenum. Smokers are also more likely to suffer from complication of GERD, such as esophagitis, Barrett's esophagus, and esophageal cancer.

Nicotine appears to be a culprit in GERD because it lowers pressure in the LES. In addition, smoking may directly irritate the esophagus, and it may also cause irritation indirectly, because cigarette smoking may decrease production of saliva, which helps protect the esophagus from acid. This means that any acid reflux will be more likely to cause damage in smokers than in nonsmokers, and that existing acid damage will be less likely to heal.

Stopping smoking has an immediate beneficial effect on GERD symptoms and risks. It can be very difficult to quit smoking and stay away from cigarettes, but a physician can prescribe medications or a nicotine patch to improve the chances of success. These aids are particularly effective when used in combination with techniques of behavior modification, which can be learned wither individually or in classes run by health professionals.