Introduction Prolonged catheter-free pH monitoring with Bravo capsule up to 96 hours has become possible and enables extended physiological evaluation of gastroesophageal reflux disease (GERD) and response to therapeutic interventions. Aim of the present study was to determine the feasibility of 96 hrs recordings using Bravo capsule that would encompass time periods both off and on therapy with Proton Pump Inhibitors (PPIs).
Methods A total of 432 patients reporting symptoms of GERD refractory to conventional therapy underwent 96 hours of Bravo capsule recordings. Patients identified with abnormal acid exposure during the 1st 48 hrs of recordings (off PPIs) underwent the 2nd 48 hrs of recording on twice daily PPIs. The parameters subjected to analysis were percent of time ph < 4 (total, upright, supine, postprandial), number of refluxes, symptoms reported by the patients and their association with acid reflux (SI+).
Results 132/436 (30.3%) of patients had abnormal acid exposure in the 1st 48 hrs (70 males, mean age 49, range 17–81 years) and the second 48 hrs of recordings was performed on PPIs.98/132 (74.2%) had normal acid exposure on PPIs whereas 34/132 (23.5%) had abnormal acid exposure despite high dose of PPIs. The overall number of symptoms reported in the 2nd 48 hrs was reduced by 68.4% (responsive 76.7% vs refractory 49.9%, p < 0.05). The number of these symptoms that were actually associated with acid reflux events was reduced by 57.5% (responsive 43.9% vs refractory 39%, p = 0.094). In patients refractory to PPIs acid reflux in upright position was identified in 23/34 (67.7%), supine in 18/34 (52.9%) and in both positions in 8/34 (23.5%). Abnormal number of refluxes was identified in (27/34)79.5% of the patients. In total 355 symptoms were recorded by patients during the 96 h of recording. 200/355 (56.3%) of these symptoms were not related to acid reflux (SI-). Prolonged Bravo recordings on PPIs identified 16/355 (4.5%) additional SI(+) symptoms that were SI(-) in the 1st 48 hrs. 139/355 (39.15%) of symptoms were SI(+) in the 1st48h of recordings and 43/139 (30.93%) remained SI(+) despite high dose of PPIs. In patients refractory to PPIs 25/41 had SI(+) symptoms whereas in the responsive 35/98 patients had SI(+) symptoms.Refractory GERD to PPIs was significantly correlated with positive symptom association (SI+) for chest pain (p = 0.01), heartburn (p = 0.043), and vomiting (p = 0.015).
Conclusion Extended pH recording improves the detection of abnormal acid reflux. Combined off and on PPI therapy pH testing provides additional information which can be helpful in the management of patients with PPI refractory GERD.
Disclosure of Interest None Declared
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