Bravo pH Test

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If you have diabetes, ask your regular doctor for diet and medication restrictions.
If you take a medication to thin your blood and have not already discussed this with our office, please call us at 612-871-1145.
If you take aspirin, you may continue to do so.
If you are or may be pregnant, please discuss the risks and benefits of this procedure with your doctor.
If you are scheduled for a MRI: After ingesting the capsule and until it is excreted, you should not have a Magnetic Resonance Imaging (MRI) examination or be near a MRI.
If you will be receiving sedation, you must arrange for a ride for the day of your exam. If you fail to arrange transportation with a responsible adult, your procedure will need to be cancelled and rescheduled.
If you must cancel or reschedule your appointment, please call 612-871-1145 as soon as possible.

PREPARATION

To ensure a successful exam, please follow all instructions carefully. Failure to accurately and completely prepare for your exam may result in the need for an additional procedure and both procedures will be billed to your insurance.

Before your exam:
Fill out the Health History form to bring with you on the day of your appointment.

Medications:
Several medications alter the pH level of the stomach and may affect the contractile pattern of the esophagus. Your doctor may choose to perform the test with or without stomach (acid-blocking) medications. Your doctor will let you know prior to the test if you should stop your medications or continue your medications.

pH Test Without Stomach Medications
Discontinue your stomach medications as listed in the chart below.
Your doctor would like to study the stomach in its natural state. The medications listed below will need to be stopped prior to the exam (other medications may be continued).
Your test will need to be rescheduled if these medications are not stopped.

7 Days Before Test
Stop taking:

  • Aciphex® (rabeprazole)
  • Nexium® (esompeprazole)
  • Prevacid® (lansoprazole)
  • Kapidex® (dexlansoprazole)
  • Prilosec® (omeproazole)
  • Protonix® (pantoprazole)
  • Zegerid® (omeprazole/ sodium bicarbonate)

2 Days Before Test
Stop Taking:

  • Reglan® (metoclopramide)
  • Pepcid® (famotidine)
  • Tagament® (cimetidine)
  • Zantac® (ranitdine)
  • Axid® (nizatidine)
  • Carafate® (sucralfate)

24 hours Before Test
Stop any Over-the-Counter antacids:

  • Tums®
  • Rolaids®
  • Maalox®
  • Mylanta®

pH Test with Stomach Medications:
If you doctor has instructed you to complete this test while you remain on stomach medications, continue all stomach medications (and any other medications) prior to the test.

The night before your exam:

  • Stop eating solid foods at 11:45pm.
  • Clear liquids are okay to drink (examples: water, Gatorade, clear broth and apple juice).
  • Do not drink red liquids or alcoholic beverages.

The day of your exam:

  • Stop drinking clear liquids 6 hours before your exam.

When you leave for the procedure:

  • Bring a list of all of your current medications, including any allergy or over-the-counter medications.
  • Bring a photo ID as well as up-to-date insurance information, such as your insurance card and any referral forms that might be required by your payer.
  • Co-pays are required on the day of your appointment.

DESCRIPTION OF THE BRAVO pH MONITORING TEST

What is the Bravo pH monitoring system?
The Bravo system is a pH test to help your doctor determine if you have acid reflux. A pH test measures the degree of acidity or alkalinity in your esophagus. The test period usually lasts 24 to 48 hours, and measures acidity in two ways:

  • How often stomach acid flows into the lower esophagus
  • Degree of acidity during the test period

Information from the pH test helps your doctor diagnose GERD (gastroesophageal reflux disease) and plan your treatment. Bravo system consists of a capsule, approximately the size of a gel cap that is temporarily attached to the wall of your esophagus. The capsule measures pH levels in you esophagus and transmits this information wirelessly to a portable receiver you wear on your waistband.

What should I expect during a Bravo test?

You will sit or lie back while your doctor inserts the pH capsule into the esophagus. After the capsule is in place, suction is applied, drawing a small amount of tissue into the capsule. The capsule is locked in place with typically little or no discomfort.

As soon as the capsule is attached, it begins measuring the pH levels in your esophagus. The capsule transmits these measurements wirelessly to a small receiver you wear on your waistband or belt. As long as the capsule and receiver are within 3 feet of each other, the system will measure and record your pH levels. This means you can place the receiver nearby when bathing or sleeping without interrupting the test.

The receiver is about the size of a standard pager, and has three symptom buttons. You will be instructed to press the appropriate button during the study when you experience heartburn, regurgitation, or chest pain. The Bravo Receiver is designed to prevent you from turning it off during the test period.

You will also be asked to record periods of eating and sleeping in a diary throughout the test. You can go about your daily routine without any restrictions.

Some people say they have a vague sensation that "something" is in their esophagus. Others say they feel the capsule when they eat or when food passes the capsule. Chewing food carefully and drinking liquids may minimize this sensation.

Please note: The capsule contains a tiny magnet, and you should not undergo an MRI study within 30 days of using the Bravo system.

What should I expect after the Bravo test?

When the pH study is complete, you will return the receiver and diary to your doctor's office. The information stored in the receiver will be uploaded to a computer. Your doctor will analyze your results to determine if you have acid reflux and plan the best treatment for your heartburn symptoms.
The disposable capsule will spontaneously detach and pass through your digestive system a few days after the test period. Only a small area of esophageal tissue is affected by the capsule.

What are the possible complications of Bravo?

If you have a bleeding tendency, narrowing of the esophagus, severe irritation of the esophagus, varices, obstructions, a pacemaker, or an implantable cardiac defibrillator, you should not undergo a Bravo pH test. Additionally, because the capsule contains a small magnet, you should not have an MRI study within 30 days of undergoing the Bravo pH test.
Rare complications from using the Bravo pH Monitoring System include the following events:

  • The capsule could detach from the esophagus before the test is complete
  • The capsule may fail to detach from the esophagus within several days after placement, or there may be discomfort associated with the pH capsule, requiring endoscopic removal
  • Tears in the lining of the esophagus, causing bleeding and requiring possible medical intervention
  • Perforation
Rev 01/25/2013