Digestive Diseases and Nutrition

Bravo ® pH Testing

Patients with heartburn or regurgitation may have acid reflux, also known as gastroesophageal reflux disease (GERD).Other symptoms of GERD may include chest pain of non cardiac origin, hoarseness, cough or asthma. The diagnosis can be made on clinical grounds by history however, confirmation is important in many instances to assure proper treatment and avoid unnecessary medications. This can be achieved by pH monitoring. Since acid reflux measurement is the hallmark of the test, your doctor will ask you to stop taking any prescription or over-the-counter (OTC) acid reducers (e.g. Prilosec®, Protonix®, AcipHex®, Prevacid®, Nexium®, Dexilant®, Zegerid®, Tagamet®, Pepcid®, and Zantac®) for 7 days prior to the test and the 48-hour recording period. Before the procedure commenses, you will be instructed to record on a diary not only your symptoms, but also meals and sleep times.

Bravo 1BRAVO® pH monitoring is a wireless, small capsule-based, patient-friendly test for identifying the presence and severity of acid reflux. The capsule is inserted by carefully advancing a thin, flexible, blunt-tip insertion device (figure on the left) through the mouth then attached to the lower end of your esophagus or swallowing tube (figure on the right). This procedure can be done at the time of upper endoscopy (with sedation) or by itself (with numbing medication to the throat). Bravo Endo

The capsule records acid exposure information and transmit them wirelessly to a recording device (receiver) for 48 hours (figure on the lower right).

Bravo Receiver

The receiver can be worn on a shoulder strap or a waistband but can also be taken off for shower or sleep as long as it is within 5 feet from your person. Because BRAVO pH monitoring is wireless (nothing will stick out of your mouth or nose), it allows you to maintain your regular activities and the convenience to record any symptoms. The capsule will eventually fall into the stomach and pass painlessly in the stool in 10-14 days.Once the recording period is over, you will be asked to return the recording device so the doctor can analyze it (figure below) and evaluate reflux symptoms by determining the frequency and duration of acid flowing back up into the esophagus.

Bravo RecordingBRAVO pH has the potential to provide a more accurate picture of acid exposure, compared to data collected using catheter-based systems where normal activities may be limited.

There is some discomfort and gagging if the device is placed without sedation. Trauma to throat can also occur very rarely from the passage of the insertion device. Some people may have a foreign body sensation in their esophagus but this will not interfere with normal swallowing.