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Gastroenterology (Expert Forum)
Bravo ph testing for acid reflux
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Bravo ph testing for acid reflux
by puddin, May 17, 2003 12:00AM
I have been diagnosed with acid reflux with a sliding hiatal hernia.. I have been taking Aciphex for six weeks and was on Protonix for two weeks prior to this. My gastroenterologist is not satisfied with results of the medication thus far. He wants to perform a Bravo ph test. Are you familiar with this test?
Is it done with the patient under sedation? The doctor I have been seeing does not use sedation for this procedure. Can you give me a little information on this procedure. If you are familiar with the Bravo procedure, and do use sedation, how well do think patients would tolerate this without sedation? I am very apprehensive about going through this without sedation.
Maybe you can ease my worries a little. Thank you for your information.
Is it done with the patient under sedation? The doctor I have been seeing does not use sedation for this procedure. Can you give me a little information on this procedure. If you are familiar with the Bravo procedure, and do use sedation, how well do think patients would tolerate this without sedation? I am very apprehensive about going through this without sedation.
Maybe you can ease my worries a little. Thank you for your information.
Doctor's Answer
by Kevin Pho, MD, May 19, 2003 12:00AM
, May 19, 2003 12:00AM
Hello - thanks for asking your question.
From my reading, sedation is used during the Bravo pH procedure. Here is a description from the Mayo Clinic:
"Using the new Bravo pH monitoring system, physicians insert a thin, flexible, lighted tube, called an endoscope, through a sedated patient’s mouth and into his or her esophagus. They locate the area of the esophagus about 2.5 inches above its junction with the stomach. They remove the endoscope and insert a special catheter with the special capsule on its tip. A small piece of the lining of the esophagus is sucked into the capsule, and it is held in place by a tiny pin. Physicians remove the placement catheter and check the capsule’s attachment with the endoscope. The capsule, about the size of a gel cap, contains a radio transmitter that sends pH data to a beeper-sized receiver worn on the waist or carried in a pocket.
Patients wake up from the procedure, go home and resume normal activities immediately while wearing the receiver. They also keep a diary of their GERD symptoms and press a symptom button on the receiver whenever they experience heartburn, chest pain or regurgitation. Patients return the receiver and their symptom diary to their doctor 48 hours later. The doctor downloads the pH data to a computer to confirm or rule out GERD. The capsule stays in place for a few days and is sloughed off by normal body processes. It passes through the gastrointestinal tract and is eliminated."
http://www.mayoclinic.org/news2002-jax/1536.html
Here is another description from Emory University:
"In a 45-minute procedure under twilight sedation, a miniature pH transmitter about the size of a capsule is attached to the wall of the esophagus by a special catheter which is immediately removed once the capsule is placed. Using radio frequency, the capsule transmits pH data to a small receiver that is worn on a belt by the patient. The receiver collects and stores data over a period of 24-48 hours, at which time the transmitter is naturally sloughed off into the patient's digestive tract and passed out of the body. The data is then uploaded from the receiver to a computer equipped with software that translates the data to provide a comprehensive report for the physician."
http://www.emory.edu/WHSC/HSNEWS/releases/june02/gi_bravo.html
So, it seems to me that sedation is used for the procedure. I have no personal experience with the Bravo pH system, but it does seem to be better tolerated than the traditional pH test.
You may want to further discuss the issue of sedation with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
From my reading, sedation is used during the Bravo pH procedure. Here is a description from the Mayo Clinic:
"Using the new Bravo pH monitoring system, physicians insert a thin, flexible, lighted tube, called an endoscope, through a sedated patient’s mouth and into his or her esophagus. They locate the area of the esophagus about 2.5 inches above its junction with the stomach. They remove the endoscope and insert a special catheter with the special capsule on its tip. A small piece of the lining of the esophagus is sucked into the capsule, and it is held in place by a tiny pin. Physicians remove the placement catheter and check the capsule’s attachment with the endoscope. The capsule, about the size of a gel cap, contains a radio transmitter that sends pH data to a beeper-sized receiver worn on the waist or carried in a pocket.
Patients wake up from the procedure, go home and resume normal activities immediately while wearing the receiver. They also keep a diary of their GERD symptoms and press a symptom button on the receiver whenever they experience heartburn, chest pain or regurgitation. Patients return the receiver and their symptom diary to their doctor 48 hours later. The doctor downloads the pH data to a computer to confirm or rule out GERD. The capsule stays in place for a few days and is sloughed off by normal body processes. It passes through the gastrointestinal tract and is eliminated."
http://www.mayoclinic.org/news2002-jax/1536.html
Here is another description from Emory University:
"In a 45-minute procedure under twilight sedation, a miniature pH transmitter about the size of a capsule is attached to the wall of the esophagus by a special catheter which is immediately removed once the capsule is placed. Using radio frequency, the capsule transmits pH data to a small receiver that is worn on a belt by the patient. The receiver collects and stores data over a period of 24-48 hours, at which time the transmitter is naturally sloughed off into the patient's digestive tract and passed out of the body. The data is then uploaded from the receiver to a computer equipped with software that translates the data to provide a comprehensive report for the physician."
http://www.emory.edu/WHSC/HSNEWS/releases/june02/gi_bravo.html
So, it seems to me that sedation is used for the procedure. I have no personal experience with the Bravo pH system, but it does seem to be better tolerated than the traditional pH test.
You may want to further discuss the issue of sedation with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Most of your questions will get answered.
I have looked on the internet under Bravo ph testing and haven't been able to find out much about whether sedation is widely used.
How do patients tolerate it without sedation?
procedure with an endoscopy. I couldn't handle the gag reflex.
Did the doctor or nurse numb you throat before proceding with the Bravo test?
How was the total time of the procedure?
I posted earlier this evening in reference to GERD and hiatal hernia. I, too, have a hiatal hernia. Now Im only making a suggestion...but before I do that, do all your doctor tells you to do, the tests, etc. After I had tests done, I told my chiropractor about the GERD and he said he wished I had told him sooner because if its caused by hiatal hernia, there is a high success rate in helping to heal the hernia. It is done by a chiropractor or osteopath who is proficient in using an instrument called an activator. It looks like a pen and the technique is like accupressure, only a little stronger and totally painless. I went from vomiting, having severe GERD especially if I ate any red sauce or orange juice to being on prevacid 2x a day....and now Im off the prevacid..I get weekly adjustments and I also take a natural digestive enzyme from the health food store. If your chiropractor is knowlegeable, he/she will tell you a misaligned jaw goes along with the hernia 9 times out of 10...well my jaw is better now too...its a simple adjustment like a pen clicking the muscle into place. Please drs. dont be upset with this post...I believe in seeing a doctor first and doing all the dr. recommends. I can now eat pizza/have orange juice and I have no GERD whatsoever, and I had been diagnosed by an expert in this field. He cant believe I dont have it anymore, especially when I told him about the adjustments. It took about 6 adjustments before it really worked. I hope this helps some other folks!
For your assurance, there is no feeling in the esophagus, you won't even know it is being put in there.
I have done this sedated before and now unsedated.
This is how it felt:
The beginning of the tube insertion I started to gag a bit, but then it stopped, then I felt a tickling feeling in my stomach (never felt any tube), after watching the procedure on the camera with the doctor, he looked around for inflammation (I never felt anything). Then he pulled up the tube ( I did not gag at all) and the nurse inserted a small tube with the bravo capsule on it, within a few seconds, she backed away and the doctor removed the tube, (still never gagged or felt anything).
As the doctor was walking away I ask if that was all there was too it, and the nurses said yes. It was done.
Now I wonder why I was ever sedated in the first place. It was too easy. And I have severe Panic Disorder, I was scared and didn't think I could do it.
But I have never had a test so easy before.
I hope this helps with your fears.