Obesity & GERD

It is worth noting that your client is either overweight, obese or extremely obese according to the information provided.  Obesity is associated with gastrointestinal reflux disease (GERD). (Howard Hapel, M.D. MSc (Epi) and Hashem B. El-Serag, M.D., MHPH META-ANALYSIS: Obesity and the Risk for Gastroesophageal Reflux Disease and Its Complications, Annals of Internal Medicine, Vol. 143, Number 3, 199-201, August 2, 2005.

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 individual’s mouth this would include alcohol from the stomach.  This contamination if a form of pre-analytic error.

GERD affects about 30% 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.

  • Medical Problems with Breath Testing Drunk Driver, British Medical Journal, Volume 289, September 29, 1984.
  • Observations on the Distribution of Alcohol in Blood, Breath and Urine, J. D. Payne, D. W. Hill and N. W. King, British Medical Journal, 22 January 1996.

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 was entitled Breath-Alcohol Analysis of a Subject with Gastroesophageal Regurgitation, D. Wells, J. Farrar, Office of Forensic Medicine and Draeger, Australia, Melbourne, Victoria, Australia, which was published in the winter/spring edition, 1997-1998 (Volume 7, No. 3 & 4, pgs. 80-83) of the California Defender Magazine as well as National Highway Traffic Safety Administration of the Department of Transportation of the United States Government.  Their 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, who has stated that “…In the absorption phase, breath alcohol values always tended to be systematically higher than venous blood alcohol levels.” Gastroesophageal Gastric-Reflux Disease (GERD) and How This Influences the Results of B reath-Acohol 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 i health people GERD can be induced with relatively modest quantities of alcohol. S. E. Kaufman and M. E. Kaye, Induction of Gastroesophageal Reflux by Alcohol, GUT, (1978), 19, 336-338.

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