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Minimally invasive test for evaluation of heartburn or related symptoms.
No Referral Required
- Please Note: This exam requires that you have an empty stomach. You should not consume any food for 8 hours before the procedure. Stop drinking all fluids (including clear liquids and water) 4 hours before the exam (minimal sips are allowed only to take your usual medications). Avoid gum and hard candy.
How It Works
The test involves a miniature pH capsule, which is approximately the size of a gel cap. The capsule is temporarily attached to the wall of your esophagus.
Your physician will first administer local anesthesia. Then, he will place a BravoTM reflux capsule into your esophagus using a delivery device.
The BravoTM reflux capsule will continually measure the pH in your esophagus. It will transmit this information to the BravoTM reflux recorder, which is worn on your belt. After the BravoTM reflux capsule has been placed, you will be instructed how to use the BravoTM reflux recorder. Then, you will leave your physician’s office and will be able to resume your normal activities.
Once the test has been completed, you will need to return the BravoTM reflux recorder according to your physician’s instructions. Then, your test data can be downloaded for analysis. Your physician will analyze the information in order to diagnose your condition.
Patient-friendly reflux testing
- Symptoms are monitored during your regular activities
- Testing is discreet and private
What to Expect
The Bravo™ reflux capsule takes only moments to place in the esophagus. The test period lasts 48–96 hours, depending on your physician’s requests. After placement, the capsule communicates wirelessly with the Bravo™ reflux recorder (meaning no tube or wire remains in your nose or mouth).
Some patients experience a vague sensation that “something” is in their esophagus. Some patients say they feel the capsule when they eat, as food passes it. Chewing food carefully and drinking liquids may minimize this sensation.
You will be given a diary to write down the times you eat, lie down, and when you have reflux symptoms (coughing, heartburn, regurgitation). This information is important for your physician to make a diagnosis — make sure to keep your diary up to date. Your physician may also ask that you stop taking certain medications during the testing period. It is critical to follow these instructions carefully for an effective test. Your physician’s office will instruct you on how to use the BravoTM reflux recorder and how to return the equipment.
Why Test for GERD?
Chronic heartburn occurs more than once per week, and has symptoms that can interfere with your daily routines. These symptoms include:
- Frequent indigestion or burning sensations in the center of the chest
- Sour or bitter-tasting fluids in the throat or mouth
- A back-up of acid in the throat, making lying flat and bending over uncomfortable
Frequent or chronic heartburn may be associated with a more serious problem known as GERD (gastroesophageal reflux disease). Damage caused by GERD can lead to more serious medical problems such as difficulty swallowing (dysphagia), narrowing of the esophagus (strictures), and Barrett’s esophagus.
The BravoTM reflux testing system is a minimally invasive test for evaluation of heartburn or related symptoms. Your doctor will analyze results from this test to determine if acid reflux is causing your symptoms and decide the appropriate treatment for you.
If you take insulin or other diabetic medicines, dosage adjustments will be provided for you. Bring your insulin with you so that you can take it after the procedure if necessary. If you are on blood thinners such as Coumadin or Plavix, let us know at the time of scheduling because they may need to be held. All other medications should be taken at their usual time with a few sips of water.
Bravo esophageal pH monitoring is a minimally invasive test that evaluates whether acid from the stomach is refluxing into the esophagus and causing various symptoms. It requires attachment of a small monitoring device onto the esophageal wall during an endoscopic procedure called upper endoscopy or EGD. While you undergo your usual daily activities for the next 2 days, the device measures the frequency and duration of acid refluxing up into your esophagus. You will record sleep, eating and symptoms in a diary. Most patients with acid reflux don’t need this test. Sometimes, ongoing symptoms despite treatment or atypical symptoms that may be caused by acid reflux will be best evaluated by this test. Be sure you discuss with your ordering physician whether acid suppression medications should be stopped or not.
You will be asked to sign a consent form at the time of the exam. The risks of EGD with esophageal pH monitoring are low (under 1%), but do include bleeding, perforation, infection, tearing of the lining, aspiration, medication reactions and heart/lung problems. Persistent chest discomfort may rarely occur and bowel obstruction is very rare. If you have concerns, contact us.
In the preparation area, you will be asked questions about your health history. Your procedure usually takes 15-20 minutes and you will be sedated for it. Once you are asleep, a standard upper endoscopy (EGD) is performed. The small pH monitoring device (size of a thin capsule) will be attached to the esophagus lining.
In recovery, your physician will discuss the results with you and give you discharge instructions. You and your driver will remain there until your sedation has worn off to a satisfactory level. After discharge, you may resume your usual activities, diet and return to work the following day. You may not drive, make important decisions or operate machinery the rest of the day. You must have someone at least 18 yrs old with you during the entire time from check-in through recovery and to drive you home after the exam (a taxi or bus is not an option). You will be sent home with your diary and the recording device. Keep the recorder near your body. The diary page should be filled out as per instructions. Both the diary and the recorder should be returned to the Huron Gastro office in 2 days. The attached capsule will slough off the esophagus lining usually in 1-2 weeks and should pass harmlessly into your stool, although you may not be aware of this. It does not need to be retrieved. You will be notified with result within 2 weeks and should follow up with your physician.
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