The Bravo Capsule is now available at Spire St Anthony's Hospital with Dr Asif Mahmood, Consultant Gastroenterologist
Heartburn is a very common symptom that can be due to underlying Gastro-oesophageal reflux disease (GORD).
GORD means that the stomach acid can reflux or splash into the gullet (oesophagus). GORD is very common and can affect up to 20% of the population at any given time. GORD can manifest with different symptoms such as regurgitation, chest pain, acidic taste in the mouth and even food sticking in the gullet. Diet and life style changes may result in some improvement but many patients depend on long term use of antacid drugs. Despite this, the symptoms are poorly controlled in many patients, which can lead to complications such as Barretts oesophagus or even cancer of the gullet. GORD is often associated with the presence of a hiatus hernia, when top portion of the stomach is pulled through the diaphragm into the chest.
It is important to determine the severity of GORD which can help us to decide on the need for surgery which, in turn, may prevent complications such as Barretts oesophagus. Previously this required insertion of a tube through the nose into the stomach for 24 hours. Most patients find this uncomfortable. They also struggle to eat, drink and even sleep normally which is vital to obtain accurate data from the patient.
The Bravo wireless PH monitoring device is a new technique which is much more patient friendly. During the endoscopy, a small capsule is attached to the lining of the gullet in the lower oesophagus. As soon as the capsule is attached, it begins measuring the acid levels in the oesophagus. The capsule sends the data wirelessly to a small receiver that patients wear on their belt. Patients are asked to record the periods of eating, drinking and sleeping in a diary throughout the study. They can also press the appropriate buttons on the receiver if they have heartburn, chest pain or regurgitation. Bravo pH study can measure for 48 or even 96 hours. This is a considerably longer period of recording than the conventional test, so it offers us much more robust information. In addition, the 96hr study allows us to measure the acid levels with and without the use of antacids which can be more informative. At the end of the recording period, patients return the data receiver. The information is analysed using the appropriate software. The capsule detaches from the gullet and passes out by day 5 in majority of patients.
Image of a Bravo capsule attached to the lining of the gullet
Depending on the results of the Bravo pH study and the response to medication, some patients may need surgery to treat their condition. Previously patients would have Nissens Fundoplication, where the top part of the stomach is wrapped around the lower oesophagus to improve the reflux barrier.
Image of the Bravo Capsule
Nowadays, there is a new anti reflux procedure, called the LINX system. During this procedure a titanium bracelet, made of magnetic beads, is implanted around the lower oesophagus to close the hiatus hernia. It is a keyhole procedure and is much less invasive than the previous surgery. Most patients go home the same or next day. Majority of patients are able to stop their heartburn medications.