title: Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter-based studies.
abstract: BACKGROUND
  Standard pH monitoring is performed over 24 h with a naso-oesophageal catheter (C-pH). Limitations include naso-pharyngeal discomfort, nausea and social embarrassment resulting in reduced reflux-provoking activities. Recently a catheter-free pH-monitoring technique has become available. The tolerability and diagnostic yield of this system in patients who failed standard monitoring remain unknown.
  
  
  OBJECTIVE
  To examine the tolerability and diagnostic outcome of catheter-free pH-monitoring technique in patients who failed standard monitoring.
  
  
  METHODS
  Patients referred for C-pH and catheter-free pH monitoring completed a tolerability questionnaire. Acid exposure in the distal oesophagus and symptom index (SI) were reviewed.
  
  
  RESULTS
  Over 4 years, 883/1751 (50%) of patients with typical reflux symptoms referred for C-pH were diagnosed with gastro-oesophageal reflux disease (GERD) based on a pathological percentage time acid exposure (%time pH <4);134 (8%) patients failed C-pH and, of these, 129 successfully completed 2-day catheter-free pH monitoring. Ninety-eight (76%) of these patients had a pathological percentage pH <4 on either day compared with 49/102 (49%) of contemporaneous C-pH patients (P < 0.01). There was no difference in SI for heartburn (35% vs. 42%; P = 0.49). The questionnaire demonstrated a preference for catheter-free pH monitoring (96%) with less restriction in activities of daily living, naso-pharyngeal discomfort, dysphagia and chest pain.
  
  
  CONCLUSIONS
  Tolerance and satisfaction with catheter-free pH monitoring are high in patients who had previously failed C-pH; catheter-free pH monitoring assists the definitive diagnosis of GERD in this group.
authors.affiliation: Functional GI Disease Unit, Clinic for Gastroenterology and Hepatology, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Sweis
authors.forename: M
authors.initials: M
authors.lastname: Fox
authors.forename: R
authors.initials: R
authors.lastname: Anggiansah
authors.forename: A
authors.initials: A
authors.lastname: Anggiansah
authors.forename: K
authors.initials: K
authors.lastname: Basavaraju
authors.forename: R
authors.initials: R
authors.lastname: Canavan
authors.forename: T
authors.initials: T
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring / Q000295:instrumentation*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult