Bravo PH Study

The Bravo™ reflux testing system is a minimally invasive test for evaluation of heartburn or related symptoms. Bravo test involves a miniature pH capsule, which is approximately the size of a gel cap. The capsule is temporarily attached to the wall of your oesophagus.

It measures how often and how much acid from the stomach enters the oesophagus over upto 96 hour period which may be accountable for your symptoms of reflux, cough or chest pain.

Since it involves an endoscopy, you will be admitted for a day procedure at a hospital. Endoscopic Procedure may take 10-20mins under anaesthesia and a Bravo™reflux capsule into your oesophagus using a delivery device will be installed. After placement, the capsule communicates wirelessly with the Bravo™ reflux recorder (meaning no tube or wire remains in your nose or mouth).

It is primarily performed for the following reasons

• Failure to do standard 24Hr PH catheter based study.
• Diagnose and quantify gastro-oesophageal reflux disease (GORD)
• To determine if chronic cough, sore throat or recurrent chest pain (With negative work up of cardiology)is secondary to reflux.
• As part of work up prior to weight loss (bariatric) surgery or Hiatus hernia repair/Nissen fundoplication
• To Differentiate functional oesophageal disorders/non acid reflux from acid reflux.
• To determine the effectiveness of medications that are given to prevent acid reflux.

You will be advised to stop your acid suppression medication as per below.

7 days before your appointment:

Any proton pump inhibitor such as:

• Omeprazole (Losec)
• Lansoprazole (Zoton)
• Rabeprazole (Pariet)
• Esomeprazole (Nexium)
• Pantoprazole (Somac)

3 days before your appointment:

Any Histamine H2 -receptor antagonist or drugs listed here:

• Ranitidine (Zantac)
• Cimetidine (Tagamet)
• Nizatidine
• Famotidine (Pepcid)
• Domperidone (Motilium)
• Metoclopramide (Maxolon)
• Mebeverine (Colofac)
• Buscopan or baclofen

One days before your appointment:

• No Antacid including over the counter i.e. Gaviscon, Mylanta, Quick-Eze
• Stop all liquid and solid meals at midnight (Fasting from night prior to procedure) or Have a light Liquid breakfast if your procedure is in the afternoon.

If you find it really hard to stop acid suppressive medication, please inform before the procedure.

Day of your appointment:

• Please present to hospital at the designated time for your admission for gastroscopy (Please see gastroscopy information sheet)
• Medications that need to be taken regularly, such as high blood pressure and heart medication, can be taken with small sips of water when you awaken in the morning.
• If you have diabetes, skipping breakfast may affect your need for diabetic medication. This should be reviewed with your gastroenterologist.
• Medications that are not essential (vitamin supplements etc) should not be taken on the day of the test until after the test is completed.

During Study

• Avoid carbonated drinks, alcohol and fruit drinks during study.
• Take your regular meals 3-4 times
• You should record all the information in the device by pressing the appropriate buttons, however if you forget to press the required button, then please write in the diary, which will be provided on the day (See below)
• If you take any medications during study Please write the names of medications in the diary along with time.

Using the Buttons

All button functions are active ONLY when backlight is ON. If backlight is OFF, pressing any of the enabled recorder buttons will turn the backlight ON. Then, pressing the desired button will record the chosen event.

• Press the appropriate symptom button once for each symptom (heartburn, regurgitation, chest pain).
• Press the supine button once when lying down or reclined less than 45 degrees, the button LED will remain illuminated until the button is pressed upon getting up.
• Press the meal button once at the start of the meal, the button LED will remain illuminated until the button is pressed again at end of the meal. Record a meal every time you eat or drink something other than water.

The green indicator light turns on for 3 seconds and a beep is heard (if the audio alert feature is turned on). This tells you that the symptom was recorded. 

Using the Diary

It is preferred that you use buttons to record everything. Diary is provided to record something you forgot to press button for or something else you may think is relevant.

• Record start time of symptoms (heartburn, regurgitation, chest pain, cough, belch, and other) on the patient diary using the time on the recorder’s display. (Example: Heartburn 14:18)
• Record start and end time of events (meals and lying down) on the patient diary using the times on the recorder’s display. (Example: Meal 13:05 – 13:45, Lying Down 21:39 – 7:07)

If your physician has instructed you to take your acid suppression medications during the study, record the name of your acid suppression medication and the exact times when you take your medication. (Example: Medication 13:45)

Remember to write down the times as displayed on the recorder

It is not expected for you to feel any different but Some patients experience a vague sensation that “something” is in their oesophagus. Some patients say they feel the capsule when they eat, as food passes it. Chewing food carefully and drinking liquids may minimise this sensation. However, if you experience severe pain then please report to your gastroenterologist or present to nearest hospital.

Your gastroenterologist will come and speak to you in endoscopy recovery and ensure you understand the instructions how to use the recorder. The Bravo™ reflux capsule will continually measure the pH in your oesophagus. It will transmit this information to the Bravo™ reflux recorder, which is worn on your belt. Once you are fully awake from anaesthesia, you will be discharged home.

You will be able to resume your normal activities. You will also be given a diary to write down the times you eat, lie down, and when you have reflux symptoms (coughing, heartburn, regurgitation) Please write down on Diary only in case you forget to press the relevant button. Please see instruction to use buttons below.

Once the test has been completed (based on the timing decided before the procedure (usually 72 or 96 hours) , you will need to return the Bravo™ reflux recorder according to your gastroenterologist’s instructions. Then, your test data can be downloaded for analysis. Your gastroenterologist will analyse the information in order to diagnose your condition.

• Please treat the equipment with respect, do not leave it in sunlight or near water.

The data captured on the Bravo™ reflux recorder will be downloaded to a computer and your doctor will view the test results. When the test is complete, the disposable Bravo™ reflux capsule falls off the wall of your oesophagus. It passes naturally with your bowel movement through your digestive tract.

• Generally Bravo PH Study is a very safe procedure.
• Risks of Gastroscopy are inherent which are mentioned in gastroscopy information sheet.

If you have any questions or need advice please contact our rooms or specialist (if after hours) using the contact details as above.

Answers to FAQ’s

• Wear loose comfortable clothing that buttons up in front as you will be required to pass the tube
  underneath your clothing.
• You should otherwise go about your daily routine and eat your regular diet in order to get a realistic recording of how much reflux occurs during your usual routine.
• You should be careful around pets and small children to make sure they do not come close enough to accidentally damage the recorder.
• Do not chew gum or eat hard candy during the study.
• You can take a bath or shower, but do not get the recorder wet. you can place the recorder outside the shower or on your nightstand. The test will not be interrupted.
• DO NOT take any antacid or anti-reflux drugs during your study unless instructed to do so by your physician.
• Recorder out of range: If the Bravo reflux recorder is too far away from the Bravo reflux capsule and reception is weak, the receiver will beep for 30 seconds and the icon 1 disappears from the screen. Move the recorder closer to you until the beeping stops and 1 reappears on the display.
• Can I have an MRI after Bravo Capsule: Undergoing an MRI while the Bravo pH capsule is inside the patient’s body may result in serious damage to the patient’s intestinal tract or abdominal cavity. If the patient did not positively verify the excretion of any Bravo™ pH capsule, the patient should contact the physician for evaluation and possible abdominal X-ray before undergoing an MRI examination.
• Recorder placement when lying down: You may remove the Bravo reflux recorder when lying down or you may leave it on you. If you choose to remove it, place it on a stable surface within arm’s length of your chest with the display facing up and the symptom buttons facing towards you.