Bravo (Esophageal pH Monitoring)

An esophageal pH test measures and records the pH levels in your esophagus to determine if you have gastroesophageal reflux disease (GERD) – the cause of heartburn. This test allows your doctor to evaluate your heartburn symptoms to determine the frequency and duration of acid coming up into your esophagus. The test can also be done to determine the effectiveness of medications or surgical treatment for GERD.

Preparation

• Let your physician know if you have a pacemaker or implantable heart defibrillator, a history of bleeding problems, dilated blood vessels, and any other previously known problems with your esophagus.
• Seven days before the monitoring period, do not take proton pump inhibitors: omeprazole (Prilosec^®), lansoprazole (Prevacid^®), rabeprazole (Aciphex^®), pantoprazole (Protonix^®), esomeprazole (Nexium^®), dexlansoprazole (Dexilante), Zegerid
• Three days (72 hours) before the monitoring period, do not take H2 blockers: ranitidine (Zantac^®), cimetidine (Tagamet^®), famotidine (Pepcid^®), nizatidine (Axid^®); or the promotility drug, metoclopramide (Reglan^®)
• 24 hours before the monitoring period, do not take antacids (Alka-Seltzer^®, Gaviscon^®, Maalox^®, Milk of Magnesia^®, Mylanta^®, Phillips^®, Riopan^®, Tums^® or any other brands)
• Four to six hours before your appointment do not eat or drink.

Procedure

A small capsule, about the size of a gel cap, is temporarily attached to the wall of the esophagus during an upper endoscopy. The capsule measures pH levels in the esophagus and transmits readings by radio telecommunications to a receiver (about the size of a pager) worn on your belt or waistband. The receiver has several buttons on it that you will press to record symptoms of GERD such as heartburn (the nurse will tell you what symptoms to record). You will be asked to maintain a diary to record certain events such as when you start and stop eating and drinking, when you lie down, and when you get back up.

Please note: Occasionally, your doctor may want you to continue taking a certain medication during the monitoring period to determine if it is effective.

Monitoring

Here is what you need to do during the 48-hour monitoring period:

• Activity: Follow your usual daily routine. Do not reduce or change your activities during the monitoring period – doing so can make the monitoring results less useful. Do not get the receiver wet – it is not waterproof!
• Eating: Eat your regular meals at the usual times. If you do not eat during the monitoring period, your stomach will not produce acid as usual, and the test results will not be accurate. Eat at least two meals a day. Eat foods that tend to increase your symptoms (without making yourself miserable). Avoid snacking. Do not suck on hard candy or lozenges and do not chew gum during the monitoring period.
• Lying down: Remain upright throughout the day. Do not lie down until you go to bed (unless napping or lying down during the day is part of your daily routine).
• Medications: Continue to follow your doctor’s advice regarding medications to avoid during the monitoring period.
• Recording symptoms: Press the appropriate button on the receiver when symptoms occur (as discussed with the nurse). Record the time you start and stop eating and drinking (anything other than plain water). Record the time you lie down (even if just resting) and when you get back up.
• Unusual symptoms or side effects: If you think you may be experiencing any unusual symptoms or side effects, call your doctor. Some patients say they have a slight sensation of something in their esophagus or feel the capsule when they eat. Chewing food carefully and drinking liquids may lessen this sensation.

You will return the receiver and diary when the monitoring period is over. The information on the receiver and diary will be downloaded to a computer and the results will be analyzed. The study data will be reviewed with you if you desire.

After Completion of the Study

• Resume your normal diet and medications.
• Your doctor will discuss the results of your test with you during your next scheduled appointment.
• Normal activities — such as swallowing, eating and drinking — will cause the disposable pH capsule to detach and pass through the digestive tract in 7 – 10 days on average.
• No MRI exams (magnetic resonance imaging) should be performed for at least 30 days following capsule insertion.

Potential Complications

• Discomfort
• Premature or failure for capsule to detach
• Tears in the mucous membranes
• Bleeding