BRAVO / 96 hour Esophageal pH Monitoring

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Important! This exam requires that you have an empty stomach. You should not consume any food for 8 hrs before the procedure. Stop drinking all fluids (including clear liquids and water) 4 hrs before the exam (minimal sips are allowed only to take your usual medications). Avoid gum and hard candy.

Medications: If you take insulin or other diabetic medicines, dosage adjustments will be provided for you. Bring your insulin with you so that you can take it after the procedure if necessary. If you are on blood thinners such as Plavix, Coumadin, Eliquis, Xarelto, or any other medications that thin your blood, let us know at the time of scheduling because they may need to be held.  All other meds should be taken at their usual time with a few sips of water.

What is it and why do I need it?

Bravo esophageal pH monitoring is a minimally invasive test that evaluates whether acid from the stomach is refluxing into the esophagus and causing various symptoms. It requires attachment of a small monitoring device onto the esophageal wall during an endoscopic procedure called upper endoscopy or EGD. While you undergo your usual daily activities for the next 4 days, the device measures the frequency and duration of acid refluxing up into your esophagus.  You will record sleep, eating and symptoms in a diary. Most patients with acid reflux don’t need this test. But sometimes, ongoing symptoms despite treatment or atypical symptoms that may be caused by acid reflux will be best evaluated by this test. Be sure you discuss with your ordering physician whether acid suppression medications should be stopped or not.

The risks

You will be asked to sign a consent form at the time of the exam. The risks of EGD with esophageal pH monitoring are low (under 1%), but do include bleeding, perforation, infection, tearing of the lining, aspiration, medication reactions and heart/lung problems. Persistent chest discomfort may rarely occur and bowel obstruction is very rare. If you have concerns, contact us. 

The procedure

In the preparation area, you will be asked questions about your health history. Your procedure usually takes 15-20 minutes and you will be sedated for it. Once you are asleep, a standard upper endoscopy (EGD) is performed. The small pH monitoring device (size of a thin capsule) will be attached to the esophagus lining. 

 After the procedure

In the recovery unit, your physician will discuss the results with you and give you discharge instructions. You and your driver will remain there until your sedation has worn off to a satisfactory level. After discharge, you may resume your usual activities and diet and return to work the following day. However, you may not drive, make important decisions or operate machinery the rest of the day.  You must have someone at least 18 yrs old with you during the entire time from check-in through recovery and to drive you home after the exam (a taxi or bus is not an option).

You will be sent home with your diary and the recording device. Keep the recorder near your body. The diary page should be filled out as per instructions. Both the diary and the recorder should be returned to the Huron Gastro office in 4 days. The attached capsule will slough off the esophagus lining usually in 1-2 weeks and should pass harmlessly into your stool, although you may not be aware of this. It need not be retrieved. You will be notified with results within 2 weeks and should follow up with your physician

Instructional Forms for your review:

Bravo Patient Brochure

General Bravo Instructions

Image of Recorder

Patient Diary Form

Bravo pH Monitoring 3D Animation Video: