Why do I need the test?
The purpose of the test is to monitor the frequency and duration of gastro oesophageal reflux during a normal day. It will help to find out if your symptoms are caused by acid reflux.

What should I expect?
Before the test:
You should stop taking indigestion medication one week before the test. Full instructions will be sent with your appointment letter since this can vary according to which drugs you are taking.You should continue taking your medication for other conditions eg diabetes, epilepsy.You should not eat or drink anything in the six hours before the test.

On arrival:
The GI Physiology Specialist Nurse will explain the procedure to you and ask you to sign a consent form. This is to ensure you understand the test and its implications.
She will ask you a series of questions about your symptoms and the medication you have taken for them. This will help with the intepretation of the results. Please bring a list of medications with you.

Description of the Procedure
A tiny pH sensor located in a capsule (25mm x 6mm x 5.5mm) is pinned temporarily to the wall of the oesophagus at the time of your gastroscopy.

The capsule transmits data using radio signals to a receiver, not much bigger than a mobile phone, that is worn around the waist. It is important that the receiver is close to your body at all times during the procedure in order not to disturb the signal between the receiver and the capsule.

You will be asked to complete a diary of your symptoms and meals/drinks during the period of your test. This will be explained to you in detail.

After 48 hours the receiver will stop recording and the pH data stored in the receiver is downloaded onto a computer.

Between 5 and 12 days after the study the probe naturally falls off the oesophagus and passes through the digestive tract.

Will I be able to feel the capsule?
Some patients say they have a vague sensation that "something" is in their oesophagus. Some patients have reported a degree of oesophageal discomfort or a slight "tugging" sensation when swallowing. Should you experience this, chewing food carefully and drinking liquids may minimize this sensation.

Will I be able to eat and drink as normal?
Yes and it is important that you eat and drink as you normally would.

Will I be able to work?
The main advantage of this new catheter-free pH system is that you are able to continue with your normal activities, whether at work, rest or play. It is important that you continue with your normal routine since this will reflect your condition more accurately.

What about night-time?
The night time recording is a very important part of the test so please ensure that the receiver stays in close contact to you. It is probably best to attach the receiver to your nightwear.

Will I be able to take any medicine for indigestion during the test?
No, all medications have the effect of reducing or masking the amount of acid present and therefore will give an inaccurate result.

Will I be aware that the probe has detached and passed thorough my system?
No, most patients are unaware of the presence of the probe and you should not feel it passing through the digestive tract.

Is the test suitable for all patients?
The test is not suitable for patients with pacemakers and certain conditions of the oesophagus.

Are there any risks associated with the test?
Complications are very rare but potential complications are those that are associated with gastrointestinal endoscopy and include, but are not limited to: perforation, haemorrhage, aspiration, fever, infection, hypertension, respiratory arrest, cardiac arrhythmia or arrest.

Patients are restricted from undergoing an MRI study within 30 days of the Bravo procedure.

Returning the Recorder
It is very important that the recorder is returned promptly since it will be required by other patients. The Specialist Nurse will provide you with a box and instructions for returning the receiver either directly to the Hospital or by Registered Post.

Current Experience
The equipment has been used clinically in the USA since May 2002 and in the UK since October 2002. There have been rare incidences of failure to attach to the oesophagus and of premature detachment of the capsule.

The GI Physiology Clinic in Reading has the largest experience of Bravo to date in the UK.

This leaflet was written by Jane Stratford, Nurse Practitioner, GI Physiology and revised in collaboration with Mr Thomas Dehn, MS FRCS, Consultant Surgeon, at The Berkshire Independent Hospital (Tele: 0118 9028012) and The Royal Berkshire and Battle Hospital NHS Trust, Reading (Tele: 0118 9877725).
Issued October 2003
Bravo is manufactured by Medtronic Functional Diagnostics, Denmark, and supplied by
Synectics Medical Ltd, UK

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