Background: Snuff (Naswar), a form of smokeless tobacco widely used in Pashtun regions, is often considered less harmful than smoking despite its potential health risks. Gastroesophageal reflux disease (GERD) is increasingly common among Naswar users, yet limited research has explored the association between smokeless tobacco use and GERD-related symptoms in Pashtun populations. This study aimed to evaluate the prevalence of Naswar use and its association with GERD symptoms and related health conditions among residents of Swat, Nangarhar, and nearby regions.

Methods: A descriptive cross-sectional study was conducted among 276 participants using a structured questionnaire. Data regarding demographic characteristics, duration and frequency of Naswar use, lifestyle habits, medical history, and GERD-related symptoms were collected. Symptoms assessed included heartburn, regurgitation, nausea, bloating, sleep disturbance due to heartburn, and the use of anti-reflux medications. Data were analyzed using descriptive statistics.

Results: Among the 276 participants, 271 (98.2%) reported Naswar use, with most users beginning between 6 and 20 years of age (56.9%). Long-term use was highly prevalent, as 36.2% had used Naswar for more than 41 years. Heartburn was reported daily by 35.5% of respondents, while 23.9% experienced regurgitation 2–3 times per week. GERD was the most commonly diagnosed disease, affecting 32.6% of participants, while many others reported associated conditions such as chronic gastritis, peptic ulcer disease, hypertension, and diabetes. A significant proportion of respondents regularly used proton pump inhibitors (43.8%), indicating a high burden of acid-related disorders. Additional lifestyle factors, including smoking, tea and coffee consumption, and spicy food intake, were also common among participants.

Conclusion: The findings indicate a high prevalence of Naswar use and GERD-related symptoms among the study population. Long-term and frequent use of Naswar may contribute to gastrointestinal disturbances and other systemic health problems. Public health awareness programs, early screening, and tobacco cessation interventions are strongly recommended to reduce the burden of GERD and related complications in Pashtun communities.

Keywords: GERD, Snuff, Diseases, Region.