The 48-Hour Bravo Esophageal pH Test: A Probe to Study Acid via Monitoring Capsule
Posted on 18 May 2009 by Gnorb || Topic(s): Health and Fitness, Life.My throat. It burns. And it’s been burning for far longer than I’d like to remember. Thing is, my doc isn’t so sure that my GERD (gastroesophageal reflux disease) is really caused by too much acid splashing my esophagus. At one point maybe, but not anymore. No, he believes what I have is NERD, or non-erosive reflux disease. (Poetic justice?) To find out, he had me go through a study called the Bravo pH Esophageal Test.
Academic Overview
The 48-Hour Bravo pH Esophageal Test monitors the esophagus (the tube connecting the mouth to the stomach) for 48 hours in order to determine whether the heartburn I’m feeling is really acid or something else. In this case “heartburn” actually means the burning in my throat, as if I’d just swallowed battery acid, rather than in my chest, as if my heart had burst into flames. (This might indicate another condition entirely, one called LPRD, or laryngo-pharyngeal reflux disease. It’s sort of like GERD, but felt in the throat, not in the chest.)
During the test, the doctor puts a 26mm capsule down the throat and sticks it to the side of the esophagus. A monitor is then given to the patient which records the capsule’s pH readings. These will, in theory, help determine if the person has GERD. Two days later, the monitor is returned. A week later the capsule will detach itself and go through the digestive track.
For more details on the test, including getting ready, check out the Cleveland Clinic’s information site on it.
My Experience
I went over to Tampa General Hospital to get implanted with the Bravo pH capsule. I got there, as per instructions, at 1:30 P.M. Got checked in, found the waiting room which overlooked Tampa Bay and Bayshore Blvd. The Wife, there with me, cracked a smile when she realized she “could see [her] old high school from here!” The soft music playing in the background made the scene like something out of a travel video. A few minutes later we looked at one of the nearby televisions and realized it was playing a travel video.
After an hour of watching, waiting, and enjoying the aroma of hot chocolate–especially aromatic considering I’d not eaten anything in almost 24 hours–the nurse stopped by with a device the size of a small-to-medium camera which I would, for the next two days, wear around my neck. This would be the external monitor, which would record all the transmissions sent from the tiny device which I would soon have implanted in me. Additionally it had three buttons which I would press every time I felt I had heartburn, regurgitation (food coming up to the back of my throat) or chest pain. Then she gave me a diary and told me to write down all my symptoms along with the time they occurred, making sure to use the time shown on the device itself, and not any other time piece. Beside the time, I would later find out, there was also a display of my current esophageal pH. I would later find this a very useful tool with which to experiment.
With all that said and done, I was brought in for the procedure. I laid down on a bed, clothes and all, and my gastroenterologist came in. He told me to gargle some numbing liquid–”DON’T SWALLOW IT!” he repeatedly reminded me.
“Aren’t you going to put me to sleep?”
“Nope. The procedure will take about a minute. The stuff you just gargled will numb your throat to quell your gag reflex.” As he said that, the nurse stuck a plastic ring in my mouth to keep it open, then strapped it to the back of my head. (Frighteningly S&M-ish.) Then he continued, “Alright, now I’m going to put this down your throat.” It was at that very moment that he pulled out this long, thin hoobajoob, about the size of my arm, out from under some desk. Oh, shit, I thought, as he asked me to turn to my side. “To make this a bit more comfortable I’ve lubricated the device with a bit of water-soluble KY-jelly.” Seriously, I didn’t need to hear that.
As I lay on my side, the doctor stuck the device in my mouth. When he got to the back of my throat he ordered me to swallow. As soon as I did he shoved the hoobajoob all the way down to just above my stomach. That’s when he turned the suction machine on. “Alright, now this will take about a minute, so just relax.”It took everything I had not to start heaving. All I could do was count. Seventy-two seconds later, he pulled out the hoobajoob. A monitoring device about the size of a #2 pencil’s eraser and ferule had been implanted in my esophagus. It would take about a week for it to dislodge itself and go through the Chamber of Doom.
The whole process, the laying down–the gargling stuff, the implantation–all took about ten minutes. It would be an hour before I ate or drank anything, as per doctor’s orders, seeing as the numbing agent I gargled also numbed the control valve which keeps food from accidentally finding its way into the lungs.
The Testing Period
Normal esophageal pH is somewhere between 4 and 7. If it goes lower it indicates that acid is being refluxed, since the stomach’s pH is between 1 and 2. If it goes higher it might indicate bile reflux, although the stomach sometimes as alkaline periods. (The pH of bile is above 8.) Sudden drops of pH (from 7.1 to 5.3, or 6.1 to 3.8) indicate acid reflux. During the testing period my pH went as low as 1.8 and as high as 8.6, possibly 8.8. All this as per the pH display in the Bravo monitoring device I now had hanging around my neck. (It really did look like a camera.) The vast majority of the time it stuck between 4 and 7, usually between 5 and 7. What this means, I have no idea. I will when I get my results back.
I was told to eat foods which would cause my symptoms, so the first thing I did was head to my parents’ house, where my father, a pizza restaurant owner for years, would be making pizza. It was delicious. Deeeelicious. I topped the pizza off with a small Starbucks frappuccinno. Yes, evil, I know, but these are foods I KNOW would bring about symptoms. There was one small hitch with my plan, however…
Did I tell you I have a bad gallbladder? Yeah, I do. Having it taken out sometime soon (probably in the next week). Runs in the family. Also doesn’t help that I spent more than my fair share of time pigging out to crapstacular food. Mia culpa, mia culpa. Problem now was all those highly acidic foods were also fatty enough to cause problems.
My gallbladder took its revenge on me not immediately, but rather the next day. (It holds grudges.) While I had heartburn after the pizza (the pH reading dropped as low as 2.0 for brief periods, but stayed mostly above the 4.0 mark), it wasn’t until the next morning that the problems really started. After my breakfast–a sandwich made of egg whites, wheat bread and kale, followed by a cup of vanilla almond milk–I started feeling bloated. Real bloated. Then suddenly I started having pains. I was having a gallbladder attack. This was at 9:30 A.M. It would be almost 7:00 P.M. that night before the attack passed. In the meantime, my pH fluctuated between way-too-acidic (pH 3) and way too alkaline (pH 8). Since I wasn’t able to eat or drink during this time, the test was pretty much ruined.
I tried to salvage the situation on the final day. I was feeling well enough to eat what I would regularly eat, including low-fat foods that would cause me symptoms, foods like barley, oats, and juice (although it never dawned on me to try out BBQ sauce). For the most part the worst food of the bunch was the barley, which always gives me problems after a while. Don’t know why, really. It goes down fine, but then about an hour later I start burning up. Same with oats. The pH monitor corroborated this observation.
Anyway, the test ended at 4:00 on the dot; that’s when the monitor shut down. I dropped it off at the hospital and was finally rid of the thing. I should be receiving the results sometime this week. At that moment all I cared about was that I could finally go back to doing things like sipping water throughout the day and eating mostly fruits and vegetables, things which I know keep my heartburn at bay, medications or no.
The hardest part of this test, gallbladder problems aside, was that I couldn’t take anything for the discomfort I felt. I couldn’t chew gum, couldn’t suck on hard candies, couldn’t drink water to wash out the acid, and certainly couldn’t take antacids. Hopefully, however, this test shows that things aren’t as bad as I thought they’d be, even though they’re obviously not good. Now that it’s over I’m only concerned with one thing: getting rid of the bad, un-salvageable gallbladder. That’s a story for some other time.
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14 Comments, Leave a Comment or Ping
Chris
(The catheter-free Bravo PH capsule Monitoring System made by Medtronic) is very dangerous and it could and will cause catastrophic and permanent damage to the esophagus. My name is Chris and I have been investigating the Bravo PH 48 hour capsule. If you know of anyone that has had the Bravo PH 48 hour test and has been seriously injured and/or has taken one’s life, Please contact me at chrisbravoph48@yahoo.com I want to hear your story. I’m gathering more information about this very dangerous and potentially deadly medical device (Bravo PH 48 hour capsule). Thank you and God Bless.
P.S. DO NOT let any Doctor, Physician or Gastroenterologist tell you that the Bravo PH 48 hour capsule is safe. It is NOT safe…….The Bravo PH 48 hour capsule (made by Medtronic) is extremely dangerous!!!
E-mail address: chrisbravoph48@yahoo.com
Aug 17th, 2009
Gnorb
I’m not entirely sure WHY the device would be dangerous (turned out just fine for me), but I if you can really prove it’s dangerous, then by all means. I’m all for cross checking and healthy skepticism.
Aug 18th, 2009
Carol
Now, why in the world would something like this cause somone to kill themselves unless you were so inclined before. Makes no sense to me. I am thinking about having it soon but I would like to have it done when they do the endoscopy. How the heck do you swallow lying down?
Sep 16th, 2009
Gnorb
Hey Carol,
As I mentioned, I didn’t have any problems with the Bravo. In fact, I found it quite useful and wouldn’t have minded if a permanent transmitter had been inserted, since that would help me keep track of the situation.
For the procedure, I wasn’t really lying down, so much as I was lying on my side. In any case, you’re not actually swallowing anything, just doing the swallowing motions to quell the gag reflex. Trust me, it helps. Of course, you’ll also have been without food for at least 8 hours, and without drink for at least… some other amount of time, so your stomach will be empty anyway. Still, it’ll prevent any dry heaves.
Good luck. I, as a non-doctor and only a person with my own experience, recommend the test.
Sep 17th, 2009
Pam Drake
You should always do your own research and draw your own conclusions before having any medical procedures. Scaring people on web sites for your own benefit (and I’m suspecting, your own financial gain) is just wrong.
Mar 8th, 2010
Sue Lawton
I have just had the ph Bravo capsule inserted into my oesophogus. All went well and I am surprised at how little discomfort I am currently feeling. The procedure was carried out by a specialist gastroenterologist at St Mark’s Hospital London and I would recommend this procedure to anyone. I was extremely apprehensive beforehand and worried myself into a very high blood pressure state. I am afraid I was greatly misled by some blogs on the internet sighting some suicidal incident which was attributed to this Bravo test. What rubbish, this is just scare mongering !
date of procedure 7/4/2010
Apr 7th, 2010
Gnorb
Sue: I agree entirely.
Apr 10th, 2010
Lana
Hi All,
I am having this test on May 10th with an EGD of which I am quite familiar. They are also doing an esophageal manometry. I was really looking forward to this test and once and for all finding out what has been plaguing me with grief for the last 25 years. But, once I actually went and talked to the specialist I wasnt so fond of the idea. Mind you, I am still having the test just not really looking forward to it anymore. See, I have been on medication for acid reflux for so long and trying new ones when the old ones failed me and even though none of them work very well anymore, they do work to a point. If I dont take my medication before I eat the slightest morsel, I suffer ALL DAY LONG. Right now I am taking Acifex in the a.m. and 150 mg of zantac 2x per day. And that isnt even doing the best job. So, when the doc told me I had to quit my meds 10 days before the test, I cried. Yes I admit it, I was a BIG BABY. But nobody that doesnt have this problem has any idea of how painful and miserable it is. He said I can continue the zantac till 3 days before and then take tums until the day before. Well, I may as well chew on a piece of paper for all the good Tums is gonna do me. So, needless to say Im scared to death, not because of the test itself but because I know what 10 days without my meds are gonna be like. By the way, has anybodys doc told them that many people who think they have acid reflux just have hormones(serotonin to be exact) that communicate with their brain too much and this is what causes the symptoms. And can usually be relieved by taking a medication such as amitryptilin? Apparently it is caused by stress, etc. I don’t think i’ve been stressed out for the last 25 years but we’ll see what happens. Doesnt explain the vomiting that procedes every meal, tho!! Would appreciate any feedback from anyone. Thanks
Apr 16th, 2010
Gnorb
Actually your doc may be right, it might not be acid. Recently, a year after this test found that I wasn’t actually having acid reflux (although I did have the symptoms), an EGD revealed I had Eosinophilic Esophagitis (EE or EoE), an inflammatory condition of the esophagus which seems to be caused by food allergies. (I had 15 eosinophils per HPF in multiple biopses.) I just got this diagnosis a few days ago, and haven’t yet followed up with my gastro (or allergist), which is why I haven’t written about it yet. Still, it’s a possibility, so make sure you ask about it.
I hope for all the best of luck to you with the test (and the preparation time).
By the way, here were the results of my Bravo Ph test:
- DeMeester score: 8.9 (<14.23 = normal)
- Total # of events: 89 (<50 every 24hrs = normal)
- Events over 5 minutes: 0
- Total exposure time: 2.6% (~4.5% = normal)
- All events occurred when standing/sitting. None when laying down.
Of course, I do still have bad acid days (especially when the gastroparesis flares up, however infrequent that may be, thankfully), but it seems that most of the time I’m fine, maybe a bit hypersensitive, and the EoE doesn’t help matters any, though.
Apr 18th, 2010
LDO
I am a big fan of the Bravo Ph Probe. I had one done in 2002, which led to my Nissen Fundilplication in 2003. I had/have suffered from Acid Reflux since I was a kid. Once I had my Nissen in 2003, I had relief for the first time in my life. When I became pregnant in 2006 with my daughter, the pregancy stretched out my Nissen and than the suffering really began. I also began to have severe pain with my gallbladder. Luckily my surgeon removed that diesased thing in 08′!!
I had forgotten how horrible, difficult and frustrating reflux can be. Since I have been a sufferer all my life, practically, at the age of 29, I have decided to indure the pain as long and for as many days as I can before taking meds that don’t really help. My choice to suffer the pain daily/hourly/every second of everyday without medication is a “stupid” one says my family and my doctor. However, meds never helped in the first place, which is why I was granted the privledge of the surgery. My surgeon says he will not fix my failed Nissen until I have all the children I plan to have. Since my husband has us on a have a child, wait 7 years than have another one plan, I have another 4 1/2 to 5 years to suffer. Looking forward to that ;0
I am now dealing and battling with my 3 1/2 year old daughters gastro. She has suffered from relux since she was born 5 weeks early. She has been on prevacid since she was a month old, etc. She already had a Traditional Ph probe in 2009, but her gastro wants to do another one. I have been fighting for my daughter to have the Bravo probe placed instead. It has and will continue to be a battle. I am taking her to an appointment this morning with her gastro to see if I can win this battle or find someone who will use the Bravo on her. She is a big kid and is well above the size of the average 4 and 5 year olds. So I am not worried about her size being an issue. My poor child has been through so much. She has been under anesthesia for various surgeries, procedures, etc. since she was 4 months old. This is just one more thing that needs to be resovled. She had an endonoscopy and a bronchscope in 08 which reveled a gapping esphogeal sphincter. I don’t understand why if they know she has reflux due to a gapping esphogeal sphincter, why don’t they go in and fix the broken thing??
I hope to get something wonderful accomplished today and that the doctor will either agree to do the Bravo on my daughter, or he will release her records to me and I can find someone who will and than fix the problem for good!!
Good Luck to you all and I hope you all find relief!
Apr 30th, 2010
Gnorb
Great comment, LDO. Thank you. As for your daughter, in the doctors’ defense, perhaps they won’t operate because they’re hoping that as she grows older, future development will lead to resolution. She’s still young and there are a lot of anatomical changes that will happen over the next few years. I can’t imagine much worse than having to endure watching your child suffer through something like this. I hope you find resolution to your child’s problem soon. Good luck.
May 16th, 2010
brooklyn
I just had the 48 Hr Bravo Esophageal pH Test done on Monday. 3 hours later after arriving home I was very ill and went to bed. When I awoke I started throwing up for several hours. I took prescribed meds for the nausea and experienced horribly painful headaches which can make you nauseas also.
I couldn’t eat. Every time I got up I experienced horrible pain in the middle of my chest. This went on for 3 days. I was barely able to get out of bed or eat. I still don’t feel well. Ironically I had no symptoms whatsoever before entering the hospital for this test. I’ve been in misery ever since. I would rather endure the heartburn then what this test put me through. The nurse said to call the doctor if there was chest pain or constant vomiting yet when I called nothing was done about it. They just told me it would pass. I can’t wait to get this thing out of my body. This is the most horrible test I have ever been through.
Jul 30th, 2010
Emily L.
I am on Prilosec, 20 mg, twice daily. Nexium at 40 mg gave me horrendous side effects, so I can’t switch to a stronger PPI.
I had a BRAVO test, and my results were “normal.”
But I know I have reflux! When I drink cold water, milk, Gatorade, etc., this is what happens: I drink the cold liquid. My esophagus warms back up again. Then I feel a column of coldness rising all the way up to my larynx. And it burns, even though I’m on the Prilosec.
I also burp constantly.
I am a singer – a classical soprano. I have lost my pure tone and my pretty high notes. The reflux is merely uncomfortable, but I myself am MISERABLE. Singing is my passion, but my larynx is always a bit swollen, as if there is something stuck in my throat. After talking for awhile, my voice feels hoarse and sore. I can sing in my mid range, quietly, for only about half an hour on a *good* day before I have pain. I used to be able to sing high (Handel’s Messiah – soprano part) for hours with mere tiredness and no pain.
PLEASE HELP. What can I do to fix this? The Prilosec is better than nothing, but I’ve done all the lifestyle and diet modifications, and I still cannot sing! My doc upped the Prilosec dose, and I’m not noticing any difference.
I don’t want to live like this. I have extremely sensitive skin that bruises and swells extremely easily. Could this be why my larynx appears to be hyper-sensitive to reflux? HOW CAN I GET SURGERY?
Sep 1st, 2010
Gnorb
Reflux medications like Prilosec don’t stop reflux. What they do is stop the secretion of acid, which is the primary caustic factor in damage to the esophagus. In other words, stuff still coming up, it’s just not causing (too much) damage. The exception to this, of course, is the upper portion of the esophagus, which is far more sensitive than the lower. If stuff’s getting that high (and it sounds like it is) you’re getting irritated in those areas, causing inflammation and mucosal buildup.
What you may want to ask for is what’s called an Esophageal Impedance test. “Rather than measuring acid, this test can measure whether gas or liquids reflux into the esophagus. It’s helpful for people who have regurgitation of substances that aren’t acidic and therefore wouldn’t be detected by a pH probe. As in a standard probe test, esophageal impedance uses a probe that’s placed into the esophagus with a catheter.” (from http://www.mayoclinic.com/health/bile-reflux/DS00651/DSECTION=tests-and-diagnosis)
As far as surgery is concerned, the only thing that you’ll be able to do is something called a fundoplication, which strengthens the LES to stop stuff from coming up. There are various types of this type of surgery, so you’ll need to do a lot of research. Still, given the symptoms you describe, it’s an option you should consider, and something you definitely need to talk to your gastroenterologist about.
Good luck.
Sep 1st, 2010
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