Casco Bay Surgery

Bravo Esophageal pH Testing

*** You must be off of your anti-reflux medication for 7 days prior to testing. ***

Goal of the test

To measure the amount of stomach acid flowing backwards (refluxing) into your esophagus during a 24-48 hour period. This will indicate whether you have an abnormal amount of reflux and will help determine whether your symptoms are due to that reflux. 

How the test works

The probe detects every time stomach acid enters your esophagus and records the acid level (pH) on a Walkman-size data recording box you will carry with you. The recording box has several buttons on it for you to push when you have heartburn or other symptoms, a meal, or during some other events. Ask the nurse before you leave if you aren't completely clear about how to use the buttons. Once the data collection box is returned (to the Endoscopy Center for tests done at Maine Medical Center), the information is loaded into a computer for analysis, printed and sent to our office. This can take several weeks. 

Two techniques are available for this study:

Importance of the exam

I use this test only when I believe it is essential for confirming acid reflux as the source of your symptoms and making an appropriate decision regarding the usefulness of antireflux surgery. For that reason anything that affects the accuracy of the test can cause me to interpret the results incorrectly. These errors can either underestimate or overestimate the degree of reflux. Although it's not likely I would do unnecessary surgery, I could very well decide against an operation that would be beneficial or curative. Usually we can identify a flawed study and repeat it.

Most common problems

1. Chest discomfort or painful swallowing - The Bravo transmitter will detach by itself and pass through your intestine undetected within 5-7 days. Some people will have a dull ache under the breastbone until that happens. 

2. Stomach isn't making acid - This occurs when someone doesn't stop taking their antireflux medication (Prilosec, Prevacid, Aciphex, Protonix, Pepcid, Zantac, Axid, Tagamet) or doesn't stop taking it long enough before the test. Put bluntly, I want you to have a bad day, with a lot of your usual symptoms. Stop your medication a week or more in advance so that you will have symptoms. Antacids (Mylanta, Maalox, TUMS, Rolaids, Gaviscon) are okay to take up until the night before the test because they are very short-acting. If going a week without medication is truly miserable even with antacids then you may stop your medication at whatever point ahead of the test will result in you having symptoms on the day of the test. Medication use is the most common reason for me to ask somebody to repeat a test. If you are feeling fine the morning of your exam, call the office so we can consider rescheduling it for another day.

3. Inaccurate symptom recording - My ability to tell whether your symptoms are due to reflux is only as accurate as your recording of those symptoms either with the buttons on the recording box or in a written diary (or, ideally, both). If you don't record the occurrences and timing of your symptoms very well, I'm more likely to make an incorrect interpretation that your symptoms aren't due to reflux. That might keep me from recommending surgery or at least delay you in getting what could be useful and curative surgery.

4. Probe position changes - The catheter either falls out or moves forward into the stomach. Depending on how far into the test this occurs, we might need to repeat it. 

5. Recording box malfunction - Occasionally it simply fails, but not often. If only the button function breaks we can compensate if you've kept a written diary of when you had symptoms, what symptoms, when you ate, etc.

Don't leave the Endoscopy Center if you have any questions about what you're supposed to do during the test. If you have any questions or problems, please don't hesitate to call us, either before or during the 24-48 hour test period.

Last updated 10/13/08