Esophageal pH Testing

What is Bravo pH monitoring?

Gastroesophageal reflux is the backward flow or reflux of food or fluid from the stomach into the esophagus. The esophagus is the tube that transports food from your mouth into your stomach. A BRAVO pH monitoring study will help identify if you have increased amounts of reflux and if it is causing your symptoms. Dr Kethu will place the BRAVO pH monitoring device in your esophagus during the upper endoscopy (EGD). The results of the study will help Dr Kethu determine your diagnosis and the best treatment for you.

How do I prepare for the test?

In addition to the upper endoscopy (EGD) instructions, please follow these instructions closely. If this is not done, we will need to reschedule the study.

Inform our office if you-

  • Have an implanted cardiac device or any medical conditions.
  • Take any medication. Certain medicines may need to be stopped before the test.Blood thinners such as Coumadin, Plavix, Aggrenox, Pradaxa, Xarelto, Effient, Plavix or Lovenox will need to be stopped before your EGD and BRAVO. Ask our office when to stop them.
  • Take antacids or acid reflux medications-
    • Stop these medicines at least 3 days before your appointment: Zantac® (Ranitidine), Tagamet® (Cimetidine), Axid® (Nizatidine), Pepcid® (Famotidine), Reglan® (Metoclopramide).
    • Stop these medicines at least 7 days before your appointment: Prilosec® (Omeprazole), Prevacid® (Lansoprazole), Nexium® (esomeprazole), Protonix® (Pantoprazole), Aciphex® (rabeprazole), Dexilant (Dexlansoprazole).

Other instructions-

  • A person you know (family member or friend) will need to pick you up after your EGD and Bravo. You will not be able to drive or take a taxi home after the test.
  • Wear loose-fitting clothing. You may need to change into a patient gown (from the waist up) during the test.
  • Do not eat anything after midnight, the night before the EGD with BRAVO.

The day of the test:

  • You may have clear liquids, but not solid food, until 4 hours prior to the procedure. Clear liquids include Gatorade, strained fruit juice (no citrus), soda, Popsicles without fruit or cream, gelatin without fruit, bullion, coffee or tea (without milk). Avoid drinking only water. You will need the sugar and electrolytes that other clear liquids provide.
  • Do not take the medicines your doctor has asked you to hold.
  • Do take any heart, blood pressure or seizure medicine at least 2 hours before leaving for the test with a few sips of water.

During the Test

When you arrive, the nurse will explain what will be done before, during and after the EGD with BRAVO placement. If you have questions, please ask. The nurse will start an IV. The IV will be used to give sedative medicine to make you sleepy and relaxed. You will be monitored closely during the study.

During the BRAVO study a special capsule will be attached to the lower lining of your esophagus. The capsule is about the size of a pencil eraser tip. The BRAVO capsule will be placed in the esophagus during the EGD.

Once the EGD with BRAVO placement is done you will rest in the recovery room. Your doctor will determine when you are able to go home. The BRAVO capsule will stay attached to the esophagus for 5-7 days. After that the capsule will naturally detach from the esophagus and will pass through your digestive tract.

How does it work?

The BRAVO capsule measures pH levels in the esophagus. The capsule will send the pH levels via signals to a BRAVO receiver during the study. The receiver is about the size of a cell phone and can be attached to your waistband or belt. You will need to keep the receiver within 3 feet at all times for the capsule signals to be sent to the receiver. You can shower or bathe, but make sure the receiver is within 3 feet of the capsule without getting wet.

The receiver has buttons that you will push during the study. You will also be given a diary. You will keep track of symptoms, when you eat, body position (lying down, sitting or standing) and peak flow measures using the buttons on the receiver and the diary. The nurse will show you how to use the BRAVO receiver and diary.

It is important that you maintain all regular activities as much as possible during the study in order to obtain an accurate assessment of reflux through a for 48- 96 hours. This includes maintaining typical meals, activities, exercise, sleep, etc., while the BRAVO capsule and receiver are in place. If you have any questions, please ask.

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