Bravo Test

What is a Bravo pH test?

The Bravo™ esophageal pH test measures the pH level of your esophagus, typically over a 48-hour period. Healthcare providers use the test to help diagnose and monitor gastroesophageal reflux disease (GERD).

The pH level of a substance tells you if something is acidic. Sometimes, too much stomach acid backs up into your esophagus. This can cause uncomfortable symptoms like heartburn. The Bravo pH test checks how often and how much acid goes up into your esophagus.

The test involves a healthcare provider (usually a gastroenterologist) placing a small capsule or probe into the wall of your esophagus. The capsule is a recording device that measures acid levels. It sends the data to a recorder that you wear around your waist.

When the testing period is over, you return the recorder to your provider so they can analyze the information. Eventually, the capsule falls off the wall of your esophagus and passes through your digestive system.

Why would I need a Bravo pH test?

Your healthcare provider may recommend a Bravo test if you have symptoms of GERD. These include:

• Heartburn
• Coughing
• Sore throat
• Hoarseness
• Burping up food

How does a Bravo pH test work?

The Bravo pH monitoring test is a system that includes:

• A pH-sensing wireless capsule that your provider puts into your esophageal tissue to measure pH levels. It’s about the size of your smallest fingernail.
• A recorder that you wear to capture the data from the capsule. This recorder is about the size of a computer mouse.
• A software system that makes it all work.

Inserting the capsule involves having a short procedure called an upper endoscopy. In this procedure, your healthcare provider passes a thin tube with a camera on the end down your throat to attach the Bravo capsule to your esophagus. This procedure is usually completed under sedation. The capsule measures pH levels in your esophagus and transmits readings to a recorder that you wear around your waist.

Once the capsule is in and you leave your provider’s office, the testing period begins. You’ll keep a diary to track things like when you start and stop eating and drinking, when you lie down and when you get back up. The recorder also has several buttons on it. When you have an uncomfortable symptom, you’ll press a certain button.

After 48 hours, you return the receiver to your provider. The capsule will detach from your esophagus and pass through your digestive system along with your poop.

It may sound complicated, but your healthcare team will explain how to use the receiver and keep a diary before you go home.

How do you prepare for the Bravo pH test?

Be sure to share your complete medical history, including any nickel allergies. The capsule contains small amounts of nickel that can cause an allergic reaction.

Let your provider know if you have a pacemaker or implantable heart defibrillator, a history of bleeding problems, dilated blood vessels or any other issues with your esophagus.

Your provider will give you specific instructions on how to prepare for the test, such as:

• Seven days before the monitoring period, don’t take proton pump inhibitors like omeprazole (Prilosec^®), lansoprazole (Prevacid^®), rabeprazole (Aciphex^®), pantoprazole (Protonix^®) or esomeprazole (Nexium^®).
• Two days (48 hours) before the monitoring period, don’t take H2 blockers like ranitidine (Zantac^®), cimetidine (Tagamet^®), famotidine (Pepcid^®) or nizatidine (Axid^®), or the promotility drug, metoclopramide (Reglan^®).
• Six hours before the monitoring period, don’t take antacids (like Alka-Seltzer^®, Gaviscon^®, Maalox^®, Milk of Magnesia^®, Mylanta^®, Phillips^®, Riopan^®, Tums^® or any other brands).
• Four to six hours before your appointment, don’t eat or drink.

Always let your healthcare provider know what medications you take daily. Occasionally, your provider may want you to continue taking a certain medication during the monitoring period to determine if it’s effective.

What happens on the day of the Bravo pH test?

A Bravo pH test takes place in an outpatient facility, hospital or in your provider’s office. Your healthcare provider will explain the procedure and what to expect. They’ll tell you about possible complications or side effects.

You should plan to have a responsible person drive you home afterward because your provider will use a sedative or another form of anesthesia so you don’t feel pain. The procedure lasts fewer than 30 minutes.

The steps you can expect are:

1. Your provider will insert an endoscope into your mouth and into your esophagus. The endoscope doesn’t interfere with your breathing.
2. They’ll attach the capsule to tissue on your esophagus and make sure it’s sending signals to the recorder.
3. You’ll spend up to an hour in recovery after your provider places the Bravo capsule. Your healthcare team will use that time to go over instructions with you.

Is the Bravo pH test painful?

No, you’ll receive medication to block the pain and relax you. You may have a sore throat afterward. If you have any symptoms that are painful or concerning, tell your healthcare provider right away.

What happens after the Bravo pH test?

After the study is complete, you’ll return the recorder and diary to your provider. The information from the recorder and diary is downloaded to a computer, so your provider can analyze the results. Then, they’ll share the results and develop a treatment plan to help manage your symptoms.

Here’s what you need to know about what happens during the two days of the study:

• Activity: Follow your usual daily routine. Don’t reduce or change your activities during the monitoring period. If you change things, the monitoring results aren’t as useful.
• Eating: Eat your regular meals at the usual times. If you don’t eat during the monitoring period, your stomach won’t produce acid as usual, and the test results won’t be accurate. Eat at least two meals a day. Eat foods that tend to increase your symptoms (without making yourself miserable). Don’t suck on hard candy or lozenges, and don’t chew gum during the monitoring period.
• Lying down: Remain upright throughout the day. Don’t lie down until you go to bed (unless napping or lying down during the day is part of your daily routine).
• Medications: Follow your provider’s advice regarding medications to avoid during the monitoring period.
• Recording symptoms: Press the appropriate button on the recorder when symptoms occur (your provider will show you how to do this). Record the time you start and stop eating and drinking (anything other than plain water). Record the time you lie down (even if you’re just resting) and when you get back up. Someone on your healthcare team will explain all of this before you go home.
• Unusual symptoms or side effects: If you think you may be experiencing any unusual symptoms or side effects, call your provider.

How long does it take for the Bravo capsule to fall off?

It takes between seven and 10 days for the capsule to come out in your poop.

What are the risks and benefits of the Bravo pH monitoring test?

The benefit of the test is that it can help diagnose GERD. Left untreated, GERD can damage your esophagus, which could lead to more serious conditions. These include Barrett’s esophagus or esophageal cancer.

Finding out that you don’t have GERD is also important. If you don’t have acid reflux, your healthcare team can then help determine what’s really causing your symptoms.

Any procedure has risks, but the Bravo test has few complications. Possible risks include:

• The recorder or capsule doesn’t work or malfunctions.
• The capsule doesn’t stay in place or falls off before the testing period is over.
• The capsule doesn’t detach when it’s supposed to.
• You have discomfort or difficulty swallowing during the testing period.
• You have a sore throat after the upper endoscopy.

There are other possible, though very unlikely, risks. These include damage to the tissue of your esophagus, bleeding or aspiration (breathing in) of the capsule.

Please note that you can’t have an MRI within 30 days of a Bravo test. This is because the capsule contains a magnet, which interferes with MRI machines.

What kind of results do you get from a Bravo test?

Some of the information your healthcare provider gets from a Bravo test includes:

• How many reflux episodes you have
• How long each episode lasts
• How often and how long you have high acidity in your esophagus (a pH reading below 4 means there’s high acidity)
• How many reflux episodes you have while asleep

They’ll analyze the results and let you know if you have high acid levels. This could mean you have GERD.

When should I know the results?

It can take up to two weeks to get the results of a Bravo test. You can ask your healthcare provider when you can expect to get them.

When should I call my healthcare provider?

Contact your provider if you have:

• Questions about the device or your diary during the 48-hour study period
• Pain or discomfort that interferes with your daily routine
• Concerns about your test results