Evaluation of Gastroesophageal Reflux Disease Using the Bravo Capsule pH System

Rona Marie A Lawenko, Yeong Yeh Lee, Rona Marie A Lawenko, Yeong Yeh Lee

Abstract

Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients' discomfort, and catheter displacement render the test as cumbersome and error-prone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-off values are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH < 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases.

Keywords: Asia; Esophageal pH monitoring; Gastroesophageal reflux disease.

Figures

Figure 1
Figure 1
Components of the Bravo capsule system. Prepackaged system consists of (1) Bravo pH capsule with delivery system, (2) pH receiver kit, (3) buffer solution, (4) vacuum pump with suction tubes; and (5) manufacturer-provided software.
Figure 2
Figure 2
Steps in placement of the Bravo capsule. (A) Position Bravo pH capsule. (B) Apply suction to catheter until 700 mmHg is reached for 60 seconds. (C) Depress plunger to advance pin. (D) Release capsule by rotating the plunger clockwise. (E) Begin pH recording.

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