The 48-Hour Bravo Esophageal pH Test: A Probe to Study Acid via Monitoring Capsule

My throat. It burns. And it’s been burning for far longer than I’d like to remember. Thing is, my doc isn’t so sure that my GERD (gastroesophageal reflux disease) is really caused by too much acid splashing my esophagus. At one point maybe, but not anymore. No, he believes what I have is NERD, or non-erosive reflux disease. (Poetic justice?) To find out, he had me go through a study called the Bravo pH Esophageal Test.

Academic Overview

The 48-Hour Bravo pH Esophageal Test monitors the esophagus (the tube connecting the mouth to the stomach) for 48 hours in order to determine whether the heartburn I’m feeling is really acid or something else. In this case “heartburn” actually means the burning in my throat, as if I’d just swallowed battery acid, rather than in my chest, as if my heart had burst into flames. (This might indicate another condition entirely, one called LPRD, or laryngo-pharyngeal reflux disease. It’s sort of like GERD, but felt in the throat, not in the chest.)

During the test, the doctor puts a 26mm capsule down the throat and sticks it to the side of the esophagus. A monitor is then given to the patient which records the capsule’s pH readings. These will, in theory, help determine if the person has GERD. Two days later, the monitor is returned. A week later the capsule will detach itself and go through the digestive track.

For more details on the test, including getting ready, check out the Cleveland Clinic’s information site on it.

My Experience

I went over to Tampa General Hospital to get implanted with the Bravo pH capsule. I got there, as per instructions, at 1:30 P.M. Got checked in, found the waiting room which overlooked Tampa Bay and Bayshore Blvd. The Wife, there with me, cracked a smile when she realized she “could see my (her) old high school from here!” The soft music playing in the background made the scene like something out of a travel video. A few minutes later we looked at one of the nearby televisions and realized it was playing a travel video.

After an hour of watching, waiting, and enjoying the aroma of hot chocolate–especially aromatic considering I’d not eaten anything in almost 24 hours–the nurse stopped by with a device the size of a small-to-medium camera which I would, for the next two days, wear around my neck. This would be the external monitor, which would record all the transmissions sent from the tiny device which I would soon have implanted in me. Additionally it had three buttons which I would press every time I felt I had heartburn, regurgitation (food coming up to the back of my throat) or chest pain. Then she gave me a diary and told me to write down all my symptoms along with the time they occurred, making sure to use the time shown on the device itself, and not any other time piece. Beside the time, I would later find out, there was also a display of my current esophageal pH. I would later find this a very useful tool with which to experiment.

With all that said and done, I was brought in for the procedure. I laid down on a bed, clothes and all, and my gastroenterologist came in. He told me to gargle some numbing liquid–”DON’T SWALLOW IT!” he repeatedly reminded me.

“Aren’t you going to put me to sleep?”

“Nope. The procedure will take about a minute. The stuff you just gargled will numb your throat to quell your gag reflex.” As he said that, the nurse stuck a plastic ring in my mouth to keep it open, then strapped it to the back of my head. (Frighteningly S&M-ish.) Then he continued, “Alright, now I’m going to put this down your throat.” It was at that very moment that he pulled out this long, thin hoobajoob, about the size of my arm, out from under some desk. Oh, shit, I thought, as he asked me to turn to my side. “To make this a bit more comfortable I’ve lubricated the device with a bit of water-soluble KY-jelly.” Seriously, I didn’t need to hear that.

As I lay on my side, the doctor stuck the device in my mouth. When he got to the back of my throat he ordered me to swallow. As soon as I did he shoved the hoobajoob all the way down to just above my stomach. That’s when he turned the suction machine on. “Alright, now this will take about a minute, so just relax.”It took everything I had not to start heaving. All I could do was count. Seventy-two seconds later, he pulled out the hoobajoob. A monitoring device about the size of a #2 pencil’s eraser and ferule had been implanted in my esophagus. It would take about a week for it to dislodge itself and go through the Chamber of Doom.

The whole process, the laying down–the gargling stuff, the implantation–all took about ten minutes. It would be an hour before I ate or drank anything, as per doctor’s orders, seeing as the numbing agent I gargled also numbed the control valve which keeps food from accidentally finding its way into the lungs.

The Testing Period

Normal esophageal pH is somewhere between 4 and 7. If it goes lower it indicates that acid is being refluxed, since the stomach’s pH is between 1 and 2. If it goes higher it might indicate bile reflux, although the stomach sometimes as alkaline periods. (The pH of bile is above 8.) Sudden drops of pH (from 7.1 to 5.3, or 6.1 to 3.8) indicate acid reflux. During the testing period my pH went as low as 1.8 and as high as 8.6, possibly 8.8. All this as per the pH display in the Bravo monitoring device I now had hanging around my neck. (It really did look like a camera.) The vast majority of the time it stuck between 4 and 7, usually between 5 and 7. What this means, I have no idea. I will when I get my results back.

I was told to eat foods which would cause my symptoms, so the first thing I did was head to my parents’ house, where my father, a pizza restaurant owner for years, would be making pizza. It was delicious. Deeeelicious. I topped the pizza off with a small Starbucks frappuccinno. Yes, evil, I know, but these are foods I KNOW would bring about symptoms. There was one small hitch with my plan, however…

Did I tell you I have a bad gallbladder? Yeah, I do. Having it taken out sometime soon (probably in the next week). Runs in the family. Also doesn’t help that I spent more than my fair share of time pigging out to crapstacular food. Mia culpa, mia culpa. Problem now was all those highly acidic foods were also fatty enough to cause problems.

My gallbladder took its revenge on me not immediately, but rather the next day. (It holds grudges.) While I had heartburn after the pizza (the pH reading dropped as low as 2.0 for brief periods, but stayed mostly above the 4.0 mark), it wasn’t until the next morning that the problems really started. After my breakfast–a sandwich made of egg whites, wheat bread and kale, followed by a cup of vanilla almond milk–I started feeling bloated. Real bloated. Then suddenly I started having pains. I was having a gallbladder attack. This was at 9:30 A.M. It would be almost 7:00 P.M. that night before the attack passed. In the meantime, my pH fluctuated between way-too-acidic (pH 3) and way too alkaline (pH 8). Since I wasn’t able to eat or drink during this time, the test was pretty much ruined.

I tried to salvage the situation on the final day. I was feeling well enough to eat what I would regularly eat, including low-fat foods that would cause me symptoms, foods like barley, oats, and juice (although it never dawned on me to try out BBQ sauce). For the most part the worst food of the bunch was the barley, which always gives me problems after a while. Don’t know why, really. It goes down fine, but then about an hour later I start burning up. Same with oats. The pH monitor corroborated this observation.

Anyway, the test ended at 4:00 on the dot; that’s when the monitor shut down. I dropped it off at the hospital and was finally rid of the thing. I should be receiving the results sometime this week. At that moment all I cared about was that I could finally go back to doing things like sipping water throughout the day and eating mostly fruits and vegetables, things which I know keep my heartburn at bay, medications or no.

The hardest part of this test, gallbladder problems aside, was that I couldn’t take anything for the discomfort I felt. I couldn’t chew gum, couldn’t suck on hard candies, couldn’t drink water to wash out the acid, and certainly couldn’t take antacids. Hopefully, however, this test shows that things aren’t as bad as I thought they’d be, even though they’re obviously not good. Now that it’s over I’m only concerned with one thing: getting rid of the bad, un-salvageable gallbladder. That’s a story for some other time.

Edit: If you want to read a bit more about my observations, check out this MedHelp thread, where I talk a bit about this.