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Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy.

AbstractBACKGROUND & AIMS:
The Bravo pH capsule is a catheter-free intraesophageal pH monitoring system that avoids the discomfort of an indwelling catheter. The objectives of this study were as follows: (1) to obtain normal values for the first and second 24-hour recording periods using a Bravo capsule placed transnasally 5 cm above the upper border of the lower esophageal sphincter determined by manometry and to assess concordance between the 2 periods, (2) to determine the optimal discriminating threshold for identifying patients with gastroesophageal reflux disease (GERD), and (3) to validate this threshold and to identify the recording period with the greatest accuracy.
METHODS:
Normal values for a manometrically positioned, transnasally inserted Bravo capsule were determined in 50 asymptomatic subjects. A test population of 50 subjects (25 asymptomatic, 25 with GERD) then was monitored to determine the best discriminating thresholds. The thresholds for the first, second, and combined (48-hour) recording periods then were validated in a separate group of 115 patients.
RESULTS:
In asymptomatic subjects, the values measured using a manometrically positioned Bravo pH capsule were similar between the first and second 24-hour periods of recording. The highest level of accuracy with Bravo was observed when an abnormal composite pH score was obtained in the first or second 24-hour period of monitoring.
CONCLUSIONS:
Normal values for esophageal acid exposure were defined for a manometrically positioned, transnasally inserted, Bravo pH capsule. An abnormal composite pH score, obtained in either the first or second 24-hour recording period, was the most accurate method of identifying patients with GERD.
AuthorsShahin Ayazi, John C Lipham, Giuseppe Portale, Christian G Peyre, Christopher G Streets, Jessica M Leers, Steven R Demeester, Farzaneh Banki, Linda S Chan, Jeffrey A Hagen, Tom R Demeester
JournalClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 7 Issue 1 Pg. 60-7 (Jan 2009) ISSN: 1542-7714 [Electronic] United States
PMID18976965 (Publication Type: Journal Article)
Topics
  • Capsule Endoscopy (methods)
  • Esophageal pH Monitoring
  • Esophagus (physiology)
  • Humans
  • Hydrogen-Ion Concentration
  • Reference Values
  • Time Factors

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