Gastroesophageal reflux disease (GERD) is similar to belching/burping. It produces essentially an inaudible belch. This condition makes the 20 minute observation deprivation period impossible to perform and leads to contamination of the breath specimen just as a belch (or burp) would lead to contamination of the breath specimen with extraneous alcohol.

GERD concerns the incompetence of the sphincter or valve between the esophagus and the stomach. Therefore, stomach contents, whether they be solid, liquid or gas would tend to rise from the stomach back up into the esophagus, pharynx and even the mouth. When the stomach contains alcohol, gases expressed from the patient’s mouth would include alcohol from the stomach. This contamination is a form of pre-analytic error.

GERD affects about 30 percent of the population. This can exist with or without signs and/or symptoms.

A. GERD has been mentioned in the medical literature as leading to erroneous results on evidentiary breath testing.

  1. Medical Problems with Breath Testing Drunk Drivers, British Medical Journal, volume 289, September 29, 1984.
  2. Observations on the Distribution of Alcohol in Blood, Breath and Urine. J.P. Payne, D.W. Hill, and N.W. King, British Medical Journal, 22 January 1996.
  3. B. GERD has been studied by David Wells of the Draeger Corporation, the manufacturers of the Breathalyzer. The first reliable machine used in evidentiary breath testing, invented by Dr. Borkenstein in the early 1950s. Their study, Breath-Alcohol Analysis of a Subject with Gastric Regurgitation, D. Wells, J. Farrar, Office of Forensic Medicine and Draeger, Australia, Melbourne, Victoria, Australia, which has been published by the National Highway Traffic Safety Administration of the Department of Transportation of the United States Government, clearly shows that gastroesophageal reflux disease can produce erroneous results which may be up to four or five times greater than the true blood alcohol levels.

    C. GERD has been studied by A. W. Jones, Ph.D., D.Sc of the Department of Forensic Toxicology University Hospital, Linkoping, Sweden, has stated that, “…In the absorption phase, breath alcohol values always tended to be systemically higher than venous blood alcohol levels.” Gastroesophageal Gastric-Reflux Disease (GERD) and how this Influences the Results of Breath-Alcohol Analysis.
    D. Hansueli Ryser, of Draeger Safety Diagnostics, Inc. and the instructor of the mandated Alcotest course, has written regarding regurgitation of stomach contents and the vapors stemming from regurgitation “are of extremely high alcohol concentration. Unfortunately, even a 15 minute waiting period cannot prevent this situation. This phenomena leads to the erroneous high alcohol measurements and must be addressed when testing for legal purposes”.

    E. Even in healthy people GERD can be induced with relatively modest quantities of alcohol. S.E. Kaufman and M.D. Kaye, Induction of Gastroesophageal Reflux by Alcohol, GUT, (1978), 19, 336-338.

    Evidentiary breath testing is unreliable in people with GERD such individuals require a blood test for reliable determination of blood alcohol content.