Gastroesophageal reflux disease (GERD), caused when the lower esophageal sphincter (LES) does not close properly, and stomach contents leak back (reflux) into the esophagus. When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation (heartburn). GERD may lead to histopathological changes in the esophagus.

The BRAVO Capsule 48hr pH Recording is a procedure that measures and records the pH in the esophagus to determine if you have Gastroesophageal Reflux Disease (GERD).  GERD is a condition in which stomach acid “refluxes” or moves back into the esophagus causing a burning sensation. If this happens on a regular basis, it can cause Barrett’s Esophogus or permanent damage. BRAVO Capsule testing can also be used to determine the effectiveness of medication or to determine if surgical treatment is needed.

Preparation

Regardless of why BRAVO Capsule testing has been recommended, there are important steps you can take to prepare for and participate in the procedure:

View Bravo pH Study Preparation Instructions

  • Provide a complete list of all the medicines you are taking — including any over-the-counter medications and natural supplements — and any allergies to drugs or other substances.
  • Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN will also want to know if you have a heart, lung or other medical condition that may need special attention before, during or after BRAVO Capsule testing.
  • It is important they know if you are taking diabetic medications or anticoagulants, blood thinners or have bleeding or clotting problems.
  • Patients are given instructions in advance that outlines what they should and should not do to prepare for capsule endoscopy.
  • Seven days before the test, do not take proton pump inhibitors such as Prilosec®, Prevacid®, Aciphex®, Protonix®), or Nexium®.
  • Two days, 48 hours, before the monitoring period, do not take the H2 blockers such as Zantac®, Tagamet®, Pepcid®, Axid®, or Reglan®.
  • Six hours before the monitoring period, do not take antacids such as Alka-Seltzer®, Gaviscon®, Maalox®, Milk of Magnesia®, Mylanta®, Phillips®, Riopan®, or Tums®.
  • Four to 6 hours before your appointment do not eat or drink.

About the Procedure

BRAVO Capsule testing involves having an Upper Endoscopy to attach the capsule to the wall of the esophogus for 48 hours. During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse and blood oxygen level will be carefully monitored. While the capsule is in place it will measure the pH level in the esophagus and transmit readings by radio telecommunications to a receiver (about the size of a pager) worn on your belt or waistband. The receiver has several buttons on it that you will press to record symptoms of GERD. You will be asked to maintain a diary to record certain events such as when you start and stop eating and drinking, when you lie down, and when you get back up. It is important that you follow your usual daily routine to get an accurate reading.

  • Eat your regular meals at the usual times. Eat at least 2 meals a day. Eat foods that tend to increase your symptoms (without making yourself miserable). Avoid snacking. Record the time you start and stop eating and drinking (anything other than plain water).
  • Remain upright throughout the day. Do not lie down until you go to bed. Record the time you lie down and when you get back up.
  • Continue to follow your doctor’s advice regarding medications to avoid during the monitoring period.
  • Press the appropriate button on the receiver when symptoms occur.

You will return the receiver and diary when the monitoring period is over. The information on the receiver and diary will be downloaded to a computer and the results will be analyzed. Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRNwill review the results and either discuss the results over the phone or at a scheduled follow-up appointment with a report of the diagnosis.

Aftercare and Recovery

  • Resume your normal diet and medications.
  • Normal activities — such as swallowing, eating and drinking — will cause the disposable pH capsule to detach and pass through the digestive tract in 7 to 10 days on average.
  • No MRI exams (Magnetic Resonance Imaging) should be performed for 30 days following capsule insertion.

Board-Certified physicians Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN care for patients in the north Atlanta, GA; area including Johns Creek GA; Cumming GA; and Lawrenceville, GA. The in-house Endoscopy Suite at Digestive Care Physicians is a Certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems or need a colorectal cancer screening, contact us at (770) 227-2222 to schedule an appointment.