title: Four-day Bravo pH capsule monitoring with and without proton pump inhibitor therapy.
abstract: OBJECTIVE
  Ambulatory pH testing often is used to guide the management of reflux symptoms that do not respond to proton pump inhibitor (PPI) therapy and to evaluate the contribution of acid reflux to atypical symptoms. Controversy exists as to whether such clinical studies are performed optimally off or on PPI therapy. The aim of the present study was to determine the feasibility of 4-day pH recordings using a pH system that would encompass time periods both before and during PPI therapy.
  
  
  METHODS
  Eighteen patients underwent 4-day ambulatory pH testing using 2 separate receivers calibrated to a single Bravo pH capsule. Rabeprazole was administered on days 2-4 of the study (20 mg orally twice a day).
  
  
  RESULTS
  Indications for pH testing were refractory heartburn, chest pain, or chronic cough. pH recordings showed that 9 patients (53%) had esophageal acid exposure values that exceeded 4% on day 1 and 7 patients (41%) had values that exceeded 5.3%. Patients showed significant and progressive reductions in acid exposure on days 2-4 of the recording period. Of the 7 patients with quantitatively abnormal levels of acid exposure on day 1, 86% had normalization by day 3.
  
  
  CONCLUSIONS
  Prolonged, esophageal pH recordings using the Bravo pH system are feasible and allow for combined testing both off and on a therapeutic trial of PPI. Such studies may allow for the acquisition of complementary information in a single test that may be useful in the management of patients with suspected gastroesophageal reflux disease symptoms.
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Chicago, IL 60611-2951, USA. i-hirano@northwestern.edu
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hirano
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D002214:Capsules; D050782:Esophageal pH Monitoring / Q000295:instrumentation*; D004947:Esophagus / Q000502:physiology; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D064750:Rabeprazole
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001562:Benzimidazoles; D002214:Capsules; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D009853:Omeprazole