Day-to-day variability in acid reflux patterns using the BRAVO pH monitoring system.
OBJECTIVE
The wireless pH monitoring system such as the BRAVO pH system is a significant advancement in the evaluation of patients with gastroesophageal reflux because of its potentially better tolerability and the ability to record data over a 48-hour period. The aim of our study was to evaluate safety, performance, tolerability, and day-to-day variability in acid reflux patterns using the BRAVO pH system.


METHODS
A total of 90 consecutive patients (48 men and 42 women) with persistent reflux symptoms underwent BRAVO pH capsule placement from October 2002 to August 2003 at a tertiary care hospital. The BRAVO pH capsule was deployed 6 cm proximal to the squamocolumnar junction under endoscopic guidance. The pH recordings over 48 hours were obtained after uploading data to a computer from the pager-like device that recorded pH signals from the BRAVO pH capsule.


RESULTS
Successful pH data over 48 hours was obtained in 90% of patients. Nearly two thirds of patients experienced a variety of symptoms ranging from a foreign body sensation to chest discomfort or pain. Four patients had severe chest pain, 3 of whom required endoscopic removal of the BRAVO pH capsule. In 74.4% of patients, number of reflux events as well as time (%) pH<4 correlated from the first 24-hour period to the second 24-hour period. However, in 28% of patients, no predictable pattern of (%) time pH<4 in the supine position was reproduced from one 24-hour period to the next 24-hour period.


CONCLUSIONS
The BRAVO pH system appears a safe and effective method of recording esophageal acid exposure. It is an acceptable alternative for patients who are unwilling or unable to tolerate nasopharyngeal catheter-based pH studies, and it has a potential advantage of the 2-day recording period.
Ahlawat
Sushil K
SK
Division of Gastroenterology, Department of Medicine, Georgetown University Hospital, Washington, DC, USA. sushilka@aol.com
Novak
David J
DJ
Williams
Dionne C
DC
Maher
Kathleen A
KA
Barton
Franca
F
Benjamin
Stanley B
SB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002214:Capsules; D050782:Esophageal pH Monitoring / Q000295:instrumentation*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D017060:Patient Satisfaction; D012044:Regression Analysis
D002214:Capsules