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The use of these pouches is only second to e-cigarettes, but e-cigarette use was declining while nicotine pouch use was "low and stable." Notably, the pouches are not approved by the FDA as nicotine replacement products helping people to quit smoking, such as Nicorette gum

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Usually, the lower oesophageal sphincter (LOS) , which separates the stomach and oesophagus, prevents backflow