Original article
Four-Day Bravo pH Capsule Monitoring With and Without Proton Pump Inhibitor Therapy

https://doi.org/10.1016/S1542-3565(05)00529-XGet rights and content

Background & Aims: Ambulatory pH testing often is used to guide the management of reflux symptoms that do not respond to proton pump inhibitor (PPI) therapy and to evaluate the contribution of acid reflux to atypical symptoms. Controversy exists as to whether such clinical studies are performed optimally off or on PPI therapy. The aim of the present study was to determine the feasibility of 4-day pH recordings using a pH system that would encompass time periods both before and during PPI therapy. Methods: Eighteen patients underwent 4-day ambulatory pH testing using 2 separate receivers calibrated to a single Bravo pH capsule. Rabeprazole was administered on days 2–4 of the study (20 mg orally twice a day). Results: Indications for pH testing were refractory heartburn, chest pain, or chronic cough. pH recordings showed that 9 patients (53%) had esophageal acid exposure values that exceeded 4% on day 1 and 7 patients (41%) had values that exceeded 5.3%. Patients showed significant and progressive reductions in acid exposure on days 2–4 of the recording period. Of the 7 patients with quantitatively abnormal levels of acid exposure on day 1, 86% had normalization by day 3. Conclusions: Prolonged, esophageal pH recordings using the Bravo pH system are feasible and allow for combined testing both off and on a therapeutic trial of PPI. Such studies may allow for the acquisition of complementary information in a single test that may be useful in the management of patients with suspected gastroesophageal reflux disease symptoms.

Section snippets

Methods

Eighteen patients were selected from those undergoing pH testing for the clinical evaluation of reflux disease. Because the feasibility and accuracy of recordings beyond 48 hours has not yet been ascertained, only patients in whom pH testing was requested off therapy were included. In this manner, the primary clinical objective would not be affected by the additional testing protocol. Patients were required to be off PPI therapy for a minimum of 2 weeks before the study. Informed consent was

Results

Eighteen patients were studied using the 2 receivers and the 4-day recording protocol. In 2 patients, the early detachment of the Bravo capsule prevented complete data analysis. One probe detached after 2 days and the second probe detached after the third day. The patient who only completed 2 days of recording was excluded from the data analysis, however, the patient whose probe detached at the end of day 3 was included. The remaining 16 patients completed the 4-day study. None of the 18

Discussion

We have shown the feasibility of prolonged 4-day ambulatory pH recordings of esophageal acid exposure in patients undergoing clinical evaluation for GERD. Recordings were completed in 89% of patients; however, 2 patients experienced incomplete recordings because of capsule detachment after 2 and 3 days. The prolonged recording window was used to allow combined pH testing of patients both off and on PPI therapy. Rabeprazole was chosen for this study because of its more rapid onset of acid

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J.E.P. has received a research grant from Medtronic.

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Copyright © 2005 American Gastroenterological Association. Published by Elsevier Ltd. All rights reserved.