Manchesters Premier Gastroenterological Specialists

What is an oesophageal pH test?

An oesophageal pH test measures and records the pH in your oesophagus to determine if you have
gastro-oesophageal reflux disease (GORD). The test can also be done to determine the effectiveness
of medications or surgical treatment for GORD. It is an alternative to the standard catheter procedure
called 24hr pH monitoring and generally much better tolerated.

What is gastro-oesophageal reflux?

 

GORD is a condition in which stomach acid refluxes or moves back into the oesophagus (the "food pipe" leading from the mouth to the stomach). It gives symptoms often described as heartburn or indigestion.

 

 

What happens during gastro-oesophageal reflux?

A specialized muscle, called the lower oesophageal muscle (sphincter), is located where the oesophagus meets the stomach. This sphincter opens to allow food and liquid to pass into the stomach, then closes.

When the sphincter does not close tightly, food particles, stomach acid and other digestive juices can splash back up into the oesophagus. When this happens, the condition is called gastrooesophageal reflux.

 

Reflux Disease

 

When reflux occurs on a regular basis, it can cause permanent damage to the oesophagus (eg Barrett’s oesophagus).

The BRAVO pH test allows the physician to assess the level of reflux over a 48 hour period.

 

 

How does the Bravo pH test work?

A small capsule, about the size of a pencil rubber, is temporarily attached to the wall of the oesophagus during an upper endoscopy (gastroscopy). The capsule measures pH levels in the oesophagus and transmits readings to a receiver worn on your belt.

 

BRAVO pH Capsule

 

The receiver has several buttons on it that you will press to record symptoms of GORD such as heartburn.

You will be asked to maintain a diary to record certain events such as when you start and stop eating and drinking, when you lie down, and when you get back up.

 

BRAVO receiver

 

 

How do I prepare for the Bravo oesophageal pH test?

Let your physician know if you have a pacemaker or implantable heart defibrillator, a history of bleeding problems, dilated blood vessels, and any other previously known problems with your oesophagus.

 

Seven days before the monitoring period, do not take proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole.

 

Two days (48 hours) before the monitoring period, do not take the H2 blockers: ranitidine, cimetidine, famotidine, nizatidine; or the promotility drug, metoclopramide.

 

Six hours before the monitoring period, do not take antacids (such as Alka-Seltzer, Rennies, Gaviscon®, Maalox®, Milk of Magnesia®, Tums® or any other brands)

 

Four to 6 hours before your appointment do not eat or drink.

 

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 a 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 receiver 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 receiver and diary when the monitoring period is over. The information on the receiver and diary will be downloaded to a computer and the results will be analyzed. After completion of the study resume your normal diet and medications.

 

Your physician will discuss the results of your test with you during your next 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.