What is the purpose of Bravo pH Monitoring?

The Bravo pH test is a way to objectively measure how frequently patients are experiencing Acid Reflux episodes.

Acid Reflux can present with a number of symptoms such as heartburn or the feeling of liquid coming up into your mouth with a sour taste. Rather than make the diagnosis of Acid Reflux based completely on history, this probe provides a direct measurement of acid exposure in the esophagus and allows the physicians to correlate your symptoms to the acid exposure.


Preparation

To properly prepare for your procedure, you need to make certain changes to your daily medication routine.

  • 7 days before the monitoring period, do not take proton pump inhibitors such as omeprazole (Prilosec®), lansoprazole (Prevacid®), rabeprazole (Aciphex®), pantoprazole (Protonix®), esomeprazole (Nexium®)
  • 2 days (48 hours) before the monitoring period, do not take the H2 blockers ranitidine (Zantac®), cimetidine (Tagamet®), famotidine (Pepcid®), nizatidine (Axid®); or the promotility drug, metoclopramide (Reglan®)
  • 6 hours before the monitoring period, do not take antacids (such as Alka-Seltzer®, Gaviscon®, Maalox®, Milk of Magnesia®, Mylanta®, Phillips®, Riopan®, Tums® or any other brands)
  • If you take insulin, consult with your physician about making any necessary changes in your daily regimen.
  • If you take medications that contain aspirin or other anti-inflammatory drugs (such as Motrin, Advil, Indocin), we recommend that you stop taking them 7 days before your procedure. They may increase your risk of bleeding after removal of a polyp or a biopsy during your upper GI endoscopy by interfering with the normal clotting of your blood.
  • If you are currently taking Coumadin, Xarelto, Plavix, Eliquis or any other blood thinner, you must check with your prescribing physician before changing or interrupting your daily routine.
  • Certain medications should be continued prior to your upper GI endoscopy. If you take cardiac (heart) or anti-hypertensive (high blood pressure) pills, take them as you normally do with small sips of water.
  • Bring a list of all your medications (prescription medications, over-the-counter medications and eye drops) with you on the day of your procedure. You may bring the medication bottles themselves.
  • Be prepared to list and describe your allergies and reactions to any medications.
  • Because you will receive a relaxing medication during your procedure, you must arrange to have a responsible adult pick you up and/or accompany you home if you will take public transportation. You may not operate an automobile or other mechanical equipment until the day following your procedure.
  • To ensure the most accurate results possible, it is important that you do not eat or drink anything after midnight on the day before your procedure. The exception is medication taken with small sips of water.

The Day of Your Procedure

On the day of your procedure plan to spend several hours at the unit to allow time for your preparation, procedure, and recovery.

Before the procedure, a nurse will greet you and assist with changing into a hospital gown. An IV will be placed in your arm. You will receive relaxing medications through the IV during the procedure. You will be lying on your side during the procedure and the endoscope will be passed through your mouth and throat to view the upper digestive tract. The doctor will then attach the Bravo capsule to the esophagus using suction. Depending on the findings of the exam, several things can be done at the time of the procedure including biopsies, removal of polyps, and control of bleeding. The procedure takes approximately 15 to 30 minutes to complete.


Recovery

After the procedure, you will be taken to the recovery area where you will be monitored until most of the effects of the relaxing medication have worn off. You may have some cramping or bloating as a result of the procedure.

You will not be allowed to drive for the rest of the day; therefore, you will need to arrange for a ride home. You will also be instructed not to work, sign important papers, or perform strenuous activities for the rest of the day. Most patients are able to eat and drink normally after their discharge from the Endoscopy unit; however, specific instructions regarding activity, eating, and medications will be given to the patient prior to discharge.

You should call the office at (714) 778-1300 to schedule a follow-up appointment within 2 weeks of your procedure. The results of the procedure and the follow-up plan will be discussed at the follow-up visit.


Once the test has begun, what do I need to know and do?

  • 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. Note: 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 2 meals per 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 receive 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. The nurse will explain this.
  • Unusual symptoms or side effects: If you think you may be experiencing any unusual symptoms or side effects, call your doctor.

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

After completion of the study:

  • Resume your normal activities
  • 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 to 10 days on average.
  • No MRI exams (magnetic resonance imaging) should be performed for 30 days following capsule insertion.

What should I expect after the Bravo test?

When the pH study is complete, you will return the receive and diary to you doctor's office. The information stored in the receiver will be downloaded to a computer. Your doctor will analyze your results to determine if you have Acid Reflux and plan the best treatment for your heartburn symptoms. The disposable capsule will spontaneously detach and pass through your digestive system a few days after the test period. Only a small area of esophageal tissue is affected by the capsule.