The Bravo pH Monitoring System

This is a patient-friendly pH test for diagnosing heartburn and reflux disease.   A miniature pH capsule, approximately the size of a gelcap, is attached to your esophagus.  Throughout the test period (generally 48 hours), the Bravo capsule measures the pH in your esophagus and transmits this information to a pager-sized receiver worn on your belt or waistband just like a pager or mobile phone.  

Preparing for the exam

Patients with pacemakers, implantable defibrillators or neurostimulators should not use Bravo as further studies are necessary in these patients.   Also tell your doctor if you have a history of gastrointestinal bleeding, esophageal strictures, severe esophagitis, varices or obstructions.

Your doctor will discuss your current medications with you – aspirin, blood thinners and herbal preparations may need to be stopped prior to the test.  If you are on any stomach medications, please ask your doctor about taking them before or during the test.  These include medications such as:  Maalox, Mylanta, Tums, Rolaids, Zantac, Axid, Protonix, Prevacid, Aciphex, Prilosec, Tagamet, or other antacids or proton pump inhibitors.

You should not take medications to treat reflux during the study UNLESS instructed to do so by your physician (sometimes the study is done to determine if reflux occurs even while on these medications).

The day of the procedure

You will likely have a procedure called an Endoscopic Gastroduodenoscopy (EGD) along with the placement of the capsule.  Anesthesia will be given in this case and you should not eat or drink after midnight the night before your procedure.  Please click here for further details.

If you have already had an EGD performed, your doctor may elect to place the Bravo capsule without doing an EGD.  In this case, mild or no sedation may be administered.   Be sure to talk to your doctor about plans in your case.

During the pH testing period following the capsule placement (48 hours)

You should go about your normal activities while keeping the receiver within 3 feet of your person.  You can place the receiver outside of the shower while bathing or on your nightstand nearby while you are sleeping.   Please let your doctor know if you work in a power plant or short-wave radio store, as this can damage the receiver and affect the test.

You will be given a diary to write down:

·        The times when you have reflux symptoms (coughing, heartburn, regurgitation),

·        When you lie down

·        When you exercise

·        When you eat

This should be your primary task for 48 hours!  You should record the time displayed on the receiver in the diary when the symptom or activity starts and ends.  There are also buttons on the receiver that you can push when you experience symptoms – instructions will be given to you on the day of your procedure.  The receiver is a valuable computer for which you are responsible (please do not damage it or get it wet).

Discharge Instructions

• If you have any difficulties, please call the Huron Valley-Sinai Hospital Endoscopy Department at (248) 937-3475 between 7:00 a.m. and 3:00 p.m. Monday through Friday.  After hours and on the weekend, please call your doctor.
• You may “feel” the capsule in your chest.  You may take pain relievers as directed by your doctor is your discomfort is more than mild.  The capsule will fall off and pass through with a bowel movement, usually in about a week.  It may take up 30 days for the capsule to pass out of the body, so you should not have an MRI for one month following your procedure.  If a MRI is necessary, an x-ray should be done to confirm that the capsule has passed.
• Chew food well and drink plenty of fluids with your meals. Avoid continuous or frequent sipping of fluids and sucking on hard candy or chewing gum as these activities will affect readings.
• Keeping the diary as instructed should be your primary task for the next 48 hours. If you experience a symptom: hit the appropriate button and jot it down!  When you are lying down or eat something: jot it down!  Write down other activities, such as when you exercise, take medications, or smoke, as well.  Be sure to record the time displayed on the monitor and write down a start and stop time.  It is important that we know how long the symptoms or activity lasted.
• The monitor you have been given is a valuable computer.  Do not get it wet or damage it.  Keep it within arm’s reach at all times. 
• You are responsible for returning the monitor to us after the 48 hour test is finished – it will turn off automatically.
• When returning the monitor and completed diary, as instructed on previous page, please go to the Surgical Area Reception desk (where you checked in today) and ask to see an Endoscopy nurse.
• The nurse will review your diary entries with you and answer any questions you may have at that time. The information in your diary and the recordings will be put into a computer and a report will be generated and sent to your doctor.

After 48 hours

48 hours after the capsule is attached to your esophagus, the test is completed.   You must return your completed diary and the Bravo receiver to the Endoscopy unit for the information to be uploaded to a computer, which provides a comprehensive report so your physician can diagnose your condition.   The capsule will fall off naturally and be eliminated from our body in a bowel movement.  You should not have an MRI study within 30 days of the Bravo procedure unless an x-ray is done to confirm that the capsule is gone.