Simultaneous recordings of oesophageal acid exposure with conventional pH monitoring and a wireless system (Bravo®)

Stanislas Bruley des Varannes ^1*, François Mion ², Philippe Ducrotté ³, Frank Zerbib ⁴, Philippe Denis ³, Thierry Ponchon ², Ronan Thibault ⁵ and Jean-Paul Galmiche ⁵

¹ Institut des Maladies de l'Appareil Digestif, France
² Fédérations des Spécialités Digestives, Hospices Civils de Lyon, France
³ Policlinique Hôpital Charles Nicolle, Rouen, France
⁴ Service des Maladies de l'Appareil Digestif, Bordeaux, France
⁵ Institut des Maladies de l'Appareil Digestif, CHU- Hôtel Dieu, Nantes, France

^* To whom correspondence should be addressed. E-mail: bruley{at}easynet.fr.

Accepted 4 April 2005

Abstract

Objectives: Oesophageal pH monitoring (pHM) is a useful test for the diagnosis of gastro-oesophageal reflux disease (GORD) but has some limitations related to the nasopharyngeal electrode. Recently a telemetric catheter-free system (CFS) (Bravo®, Medtronic) was developed. The aim of this study was to determine the concordance of data between pHM and CFS Bravo®.

Methods: Forty patients with symptoms suggestive of GORD underwent 24-hr oesophageal pH monitoring using pHM with a nasopharyngeal electrode and the Bravo® CFS simultaneously. The sensitive tips of both electrodes were positioned at the same level under fluoroscopy. In addition to automatic analysis, each reflux episode was checked visually and characterized.

Results: There was a significant correlation (r=0.87, p<0.0001) between the 24-h oesophageal acid exposures recorded by pHM and CFS. 24-h oesophageal acid exposure was significantly lower with CFS than with pHM (2.4[0.4-8.7] vs 3.6[0.7-8.6] p< 0.0001). Consequently, with CFS, the cut-off level for the diagnosis of GORD as calculated from the regression equation was 2.9% (for the 4.2% cut-off determined in controls with pHM). After this adjustment, the concordance of the diagnosis of GORD was 88% (kappa: 0.760). Diagnosis of GORD was established in more patients with the CFS 48-hr results than with the 24- hr results.

Conclusions: Despite strong correlations between oesophageal acid exposures recorded with the two devices, the Bravo® CFS significantly under-recorded acid exposure compared to the conventional pHM. Provided some correcting factors are used, the Bravo® CFS can improve the sensitivity of pHmetry for the diagnosis of GORD by allowing more prolonged recordings.

Keywords: ambulatory recordings, diagnosis, gastrooesophageal reflux disease, pH monitoring

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