Test / Diagnostic Procedure: Bravo Oesophageal pH Test

The Bravo pH test measures the pH level of your oesophagus. If stomach acid backs up into the oesophagus (the “food pipe”) this can increase the acidity level in your oesophagus.

As well as stomach acid, remnants of food and other digestive fluids can also return up your oesophagus. When reflux happens regularly, it can cause permanent damage to the oesophagus. The Bravo pH test reveals how frequently the contents of your stomach reflux into the lower oesophagus, and how acidic it is.

If your consultant thinks you might have gastroesophageal reflux disease (GORD), they might ask you to have a Bravo pH test.

Consultant Gastroenterologist, Dr Rami Sweis, provides an overview of what a wireless pH monitoring involves.

The Bravo pH monitoring test is a complete system that includes:

• A wireless capsule that is placed into oesophageal tissue to measure pH levels.
• A wireless recorder that you wear during the test to capture the data from the capsule.

A small capsule, about the size of a gel cap, is attached to the wall of the oesophagus during a gastroscopy. The capsule will only be in place temporarily; it measures pH levels in the oesophagus and transmits readings to the wireless recorder (about the size of a pager) worn on your belt or waistband.

The wireless recorder has several buttons on it that you will press to record symptoms of GORD such as heartburn or a sore throat. You will be asked to keep an accurate record or diary to keep track of events like when you eat and drink, when you go to bed and when you get up.

Seven days before the monitoring period, stop taking any proton pump inhibitors.

Two days (48 hours) before the monitoring period, stop taking any H2 blockers.

Six hours before the monitoring period, stop taking antacids such as Gaviscon or Rennie.

Stop eating all food, including milk, six hours before your appointment, and after that drink only water up to two hours before your procedure.

Your procedure will take place in the OneWelbeck Endoscopy Centre. On the day of your appointment, you should wear comfortable clothing and you will be asked to change into a gown once you check in to your private patient pod.

Because we use sedation at OneWelbeck, you must have a responsible adult to pick you up after the procedure.

Your consultant will apply a local anaesthetic at the back of your throat as well as using a light sedation so you are in ’twilight sleep’. An endoscope is inserted into your mouth and into your oesophagus. The endoscope does not interfere with your breathing. Your consultant will attach the capsule to tissue in your oesophagus and make sure that the capsule is sending signals to the wireless recorder. You might be somewhat aware of something being in your throat, and your throat might be a little sore.

The procedure lasts only a few minutes.

During the study, follow these guidelines:

Activity: Follow your usual daily routine during the monitoring period, and don’t make any drastic changes to your normal activities. Please note that the receiver is not waterproof.

Eating: Eat your regular meals as you usually would. If you don’t eat during the monitoring period, your stomach won’t produce acid as it normally does, and the test results will not be accurate. Eat at least two meals a day, and we recommend eating foods that usually increase your symptoms (such as heartburn). Avoid snacking, don’t suck on boiled sweets, and do not chew gum.

Lying down: Remain upright throughout the day, and do not lie down until you go to bed at night (unless napping or lying down during the day is part of your normal routine).

Medications: Continue to follow your consultant’s advice regarding medications to avoid during the monitoring period.

Recording symptoms: Press the appropriate button on the receiver when symptoms occur (this will have been discussed with you with the team at OneWelbeck after your procedure). You must always record the times you eat and drink (anything other than plain water), and you must always record the time you lie down (even if you’re just resting or having a nap) 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 the OneWelbeck Endoscopy Centre team.

You’ll return the wireless recorder and diary when the monitoring period is over. The information on the recorder and your diary will be uploaded and analysed by your consultant.

Assessing whether you have acid reflux is important. If you do have a more serious condition (GORD), it could be causing long-term damage to your oesophagus, which could mean you could then develop problems that are more serious. These include oesophageal cancer or Barrett’s oesophagus.

It is also important to find out that you don’t have acid reflux. You could have been prescribed medication for a condition you don’t actually have, which should be avoided wherever possible. If you don’t have acid reflux, your consultant will then take the next steps to find out what is causing your symptoms.

Every procedure has its own risks; the Bravo test has minimal complications. These include technical problems with the equipment and set-up that make the results unreliable. The capsule might not stay in place for the full monitoring period, or it might not come away when it’s supposed to.

Some patients who have this test might feel some discomfort when they swallow, some degree of chest pain, or back pain. You may have a sore throat from the endoscopy procedure for a day or so.

Very rare risks include damage to the tissue of your oesophagus or intestines, possible bleeding or aspiration of the capsule.