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In particular, cigarette smoking in the context of both current smoking and prenatal exposure is a strong modifier of DNA methylation

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Hormone Imbalances Reproductive hormones like estrogen, progesterone, and testosterone act on the GI tract as well, and imbalances in one or more of these hormones can promote heartburn/reflux in some cases

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However, as discussed below, this finding is most plausibly explained by healthy switcher bias, residual confounding by age, body mass index, and other unmeasured factors, and the variable and uncontrollable effects of prior tobacco exposure in the vaping group, rather than by any protective effect of e-cigarette use