Evaluation of Gastroesophageal Reflux Disease Using the Bravo Capsule pH System

Abstract

Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients' discomfort, and catheter displacement render the test as cumbersome and errorprone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-off values are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH < 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases.

Randomised clinical trial: the effectiveness of Gaviscon Advance vs non‐alginate antacid in suppression of acid pocket and post‐prandial reflux in obese individuals after late‐night supper

“…The Bravo capsule was inserted orally using a delivery device under endoscopy guidance as previously described 13 . Usually, the Bravo capsule is placed 6 cm above the squamous‐columnar junction (SCJ) but in our study, we placed the capsule at the cardia where the acid‐pocket is situated, based on the technique previously published 14 .…”

Robotics in the Gut

“…While capsule endoscopes can be used to non‐invasively view the inflammation and lacerations from the acid reflux episodes, invasive catheter‐based pH monitoring is the standard diagnostic test for GERD. The Bravo pH wireless capsule system by Medtronic is less invasive and provides comparable diagnostic yields . However, the Bravo pH capsule still needs to be temporarily implanted and removed using an endoscope.…”

Need of Combining Proton Pump Inhibitors with Prokinetics: A Prospective Observational Survey Conducted in India

“…FSSG score has been validated against the endoscopic findings in Japan with the cut-off score at 8 (FSSG score 8 or above), showed sensitivity of 62%, specificity 59% and accuracy of 60%. [12][13][14] Miyamoto et al found that high score FSSG is one of the factors related to failure of PPI monotherapy, in addition to female, alcohol consumption and obesity. Thus, GERD with a high FSSG score requiring PPI combination therapy with pro-kinetic drug for a more satisfactory outcome.…”