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Further research is needed to determine whether or not chewing tobacco use presents a significant risk of heart disease and stroke

Results in Real Numbers Sphincter pressure reduction : 40% decrease in lower esophageal sphincter pressure in smokers Increased relaxation frequency : 3-fold increase in transient lower esophageal sphincter relaxations Impaired acid clearance : 50% longer esophageal acid clearance times in smokers Reduced saliva production : 30% decrease in saliva flow rate and bicarbonate content Increased reflux episodes : 2-3 times more reflux episodes per hour in smokers Symptom severity : 60% higher symptom scores in smoking GERD patients Safety, Limits, and Caveats The study examined acute and chronic effects of smoking but didnt extensively assess the reversibility of these mechanisms after smoking cessation

This list reflects the same tests that have been required since RHCs were established in 1978 (43 FR 30529) and were chosen because they were commonly performed in physicians' offices at that time